Assessment of persistent fifth aortic arch by echocardiography and computed tomography angiography

Abstract

To evaluate the utility of echocardiography (echo) in the diagnosis of persistent fifth aortic arch (PFAA), a very rare congenital aortic arch anomaly, and to compare echo and computed tomography angiography (CTA) imaging findings to improve our understanding of this anomaly. Data on the clinical diagnosis, imaging findings, and clinical management of PFAA were retrospectively analyzed in 10 suspected cases of PFAA admitted to our hospital between January 2012 and February 2017. We compared echo as a first line examination modality, and CTA and surgery results as the gold standard. Weinberg's classification was used to classify the type of PFAA. All patients (100%) received echo examination, eight patients (80%) received CTA examination, and four patients (40%) received sternotomy surgery; all recovered well after surgery. According to Weinberg's classification, 2, 6, and 2 cases (20%, 60%, and 20%) were classified as Type A, B, and C, respectively. Echo was able to diagnose 5 cases of PFAA (1 Type A case and 4 Type B cases) in the first instance. The diagnostic conformance rate of echo was 62.5% after comparisons with CTA and surgery results. The clinical manifestation of PFAA was atypical, and its diagnosis depended primarily on medical imaging. Echo has a relatively high diagnostic accuracy for PFAA, which is very valuable for its early detection.

Persistent fifth aortic arch: a single-center experience, case series

“…In pediatric cardiology, echocardiography is accessible, easy to operate, and an accurate diagnostic modality, with a reported diagnostic rate as high as 62.5% for PFAA (9). The objective of this article is to improve the understanding and diagnosis of PFAA through a single-center experience by comprehensive echocardiographic evaluation combined with computed tomography angiography (CTA) when necessary.…”

Confusion from prenatal diagnosis: Type C persistent fifth aortic arch or right‐side ductus arteriosus

“…The accuracy of the PFAA or right-side ductus arteriosus diagnosis is important as the former is often associated with other congenital heart defects, including complex great vessel anomalies, such as pulmonary atresia, aortic atresia, or aortic interruption. 7 Herein, the fetus had a DAA and subaortic LBCV with a good reproductive outcome. The existence of the fifth arch artery remains debatable because of the lack of evidence from amniote embryology to prove the existence of a transient "5th" arch/pouch.…”

Computed tomography angiography assessment of the degree of simple coarctation of the aorta and its relationship with surgical outcome: A retrospective analysis

“…However, TTE imaging has significant limitations in assessing aortic lesions due to its poor quality and occasional inaccuracies in assessing aortic branching vessels ( 18 ). CTA, as a developed imaging technique, has high spatial resolution and a wide field of view, which is helpful to comprehensively describe the CoA and help surgeons completely understand the condition of aortic coarctation ( 19 ). The predictive effect of aortic coarctation on surgical prognosis further confirmed the necessity of preoperative CTA examination.…”