ABSTRACT
Neonates with congenital rubella syndrome (CRS) are known to have associated congenital cardiac malformations. Patent ductusarteriosus (PDA) is one the most common cardiac anomalies associated with CRS. PDA refractory to medical management andassociated with ventilatory dependence is considered for surgical ligation. However, the management of PDA can be challenging in thepresence of underlying lung disease or pulmonary vascular disease. Outcomes after closure in neonates are dependent upon age,weight, nutritional status, pre-operative pulmonary arterial hypertension and presence of chronic lung disease. We present a neonatewith CRS who required surgical PDA closure. The neonate developed severe pulmonary arterial hypertension which led to fatal outcome.The clinical course is corroborated with histo-pathological changes observed on the autopsy of this neonate.