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Ann Thorac Surg 2006;81:1908
© 2006 The Society of Thoracic Surgeons

Images in cardiothoracic surgery

Persistent Fifth Aortic Arch

Jinichi Iwase, MD * , Masanobu Maeda, MD, Shigeru Sasaki, MD, Akihiro Mizuno, MD

Department of Cardiovascular Surgery, Aichi Children's Health and Medical Center, Aichi, Japan

* Address correspondence to Dr Iwase, Department of Cardiovascular Surgery, Aichi Children's Health and Medical Center, 1–2 Osakada, Morioka-cho, Obu, Aichi 474–0031, Japan (Email: jin_achemec{at}abelia.ocn.ne.jp).

A male infant was born at term after an uneventful pregnancy by a normal vaginal delivery. His birth weight was 2448 g, and the Apgar score was 10 at 1 and 5 minutes. On his second day of life, he presented with worsening tachypnea and cyanosis. An interrupted aortic arch was initially suspected by his pediatrician, by means of echocardiography, and he was transferred to our institution due to deteriorating hemodynamic condition. Echocardiography on admission revealed aortic coarctation with patent ductus arteriosus. No intracardiac lesion was seen. Prostaglandin E1 was infused to maintain blood flow in the lower body. Three-dimensional computed tomography confirmed the diagnosis as persistent fifth aortic arch with coarctation. The aortic arch was interrupted at the level of the fourth aortic arch and persistent fifth aortic arch was clearly demonstrated in an oblique right posterior view (Fig 1, arrow).


Figure 1
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  		Fig 1.
 
Surgical repair was performed through left posterolateral thoracotomy in the fourth intercostal space. Patent ductus arteriosus was divided and the coarctation was resected. A direct end-to-side anastomosis from the distal aorta to the proximal fifth arch was performed. The pressure gradient between the upper and lower limbs disappeared.

Persistent fifth aortic arch was first described by Van Praagh and Van Praagh in 1969 [1]. This arch anomaly is thought to be very rare. Therefore the diagnosis may require some knowledge and experience. Multidetecter computed tomography was very helpful in this case.


   References
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 References
 

  1. Van Praagh R, Van Praagh S. Persistent fifth arterial arch in man. Congenital double lumen aortic arch Am J Cardiol 1969;24:279-282.[Medline]



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Home page
 Ann. Thorac. Surg.Home page
Y.-H. Zhao, Z.-K. Su, J.-F. Liu, D.-F. Cao, and W.-X. Ding
Surgical Treatment of Persistent Fifth Aortic Arch Associated with Interrupted Aortic Arch
Ann. Thorac. Surg., September 1, 2007; 84(3): 1016 - 1019.
[Abstract] [Full Text] [PDF]

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