Li Xiaobing, Li Jia, Qin Wenjun, Zhang Rufang
Department of Pediatric Cardiothoracic Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China.
Transl Pediatr. 2022 Feb;11(2):306-310. doi: 10.21037/tp-21-350.
Persistent fifth aortic arch (PFAA) is a rare congenital cardiovascular anomaly of the aortic arch, which can occur independently but is frequently associated with other cardiovascular malformations including patent ductus arteriosus (PDA), interrupted aortic arch (IAA), pulmonary atresia, tetralogy of Fallot, and transposition of the great vessels. PFAA can be classified into three different types according to different abnormal vascular connections (type A, B and C). We report an infant diagnosed with PFAA along with interrupted fourth aortic arch (type B) and PDA. Several surgical methods have been delivered to patients diagnosed with PFAA. In our case, the correction of coarctation PFAA and the ligation of PDA were performed without cardiopulmonary bypass through left lateral thoracotomy. We removed the coarctation part of the PFAA, and then performed the end-to-end anastomosis between the fifth aortic arch and the descending aorta. Despite the stenosis at the site of anastomosis was observed 10 months after the operation, the patient resulted in good recovery by once balloon dilation procedure. Thus, we recommend it is more appropriable to select this procedure in the surgical treatment of PFAA for those patients whose fourth aortic arches were interrupted with fifth aortic arches well developed. Our experience can provide a beneficial reference for future cases.
持续性第五主动脉弓（PFAA）是一种罕见的主动脉弓先天性心血管异常，可独立发生，但常与其他心血管畸形相关，包括动脉导管未闭（PDA）、主动脉弓中断（IAA）、肺动脉闭锁、法洛四联症和大动脉转位。根据不同的异常血管连接，PFAA可分为三种不同类型（A、B和C型）。我们报告一例诊断为PFAA合并第四主动脉弓中断（B型）和PDA的婴儿。已为诊断为PFAA的患者采用了多种手术方法。在我们的病例中，通过左侧胸廓切开术在非体外循环下进行了PFAA缩窄的矫正和PDA的结扎。我们切除了PFAA的缩窄部分，然后在第五主动脉弓和降主动脉之间进行了端端吻合。尽管术后10个月在吻合部位观察到狭窄，但通过一次球囊扩张手术患者恢复良好。因此，我们建议对于第四主动脉弓中断且第五主动脉弓发育良好的患者，在PFAA的手术治疗中选择该手术更为合适。我们的经验可为未来的病例提供有益的参考。
