Persistent fifth aortic arch: an ignored and underestimated disease

Area of Science:

• Cardiology
• Congenital Heart Disease
• Vascular Anatomy

Background:

• The persistent fifth aortic arch is a rare congenital anomaly.
• Previous literature primarily describes its association with other great vessel anomalies like pulmonary atresia.
• Its role as an isolated finding with significant hemodynamic impact has been less understood.

Observation:

• Two unique cases of persistent fifth aortic arch were identified.
• These cases lacked associated great vessel anomalies typically seen with this condition.
• A significant left-to-right shunt was present, leading to severe pulmonary hypertension and heart failure.

Findings:

• The persistent fifth aortic arch, in isolation, can cause a large left-to-right shunt.
• This shunt can result in severe pulmonary hypertension and heart failure.
• Accurate preoperative diagnosis can be challenging due to the anomaly's rarity and complexity.

Implications:

• This study highlights the potential for isolated persistent fifth aortic arch to cause severe cardiovascular complications.
• It underscores the importance of considering this anomaly even in the absence of other great vessel defects.
• Improved diagnostic strategies are needed to prevent misdiagnosis and ensure timely intervention for affected patients.