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How frequent is the fifth arch artery?

Published online by Cambridge University Press:  29 October 2014

Saurabh K. Gupta ,
Simon D. Bamforth  and
Robert H. Anderson
Saurabh K. Gupta
Affiliation:
Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
Simon D. Bamforth
Affiliation:
Institute of Genetic Medicine, Newcastle University, United Kingdom
Robert H. Anderson*
Affiliation:
Institute of Genetic Medicine, Newcastle University, United Kingdom
*
Correspondence to: Professor R. H. Anderson, 60 Earlsfield Road, London SW18 3DN, United Kingdom. Tel: +0 044 208 870 4368; E-mail: sejjran@ucl.ac.uk
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Abstract

Although usually shown in embryology textbooks, the presence of the fifth pair of pharyngeal arch arteries has long been controversial. To the best of our knowledge, six pairs of bilaterally symmetrical arteries developing within the pharyngeal arches are yet to be found in any mammalian or avian species. Collateral channels between the distal ends of the fourth and sixth arch arteries, in contrast, have been found in up to half of all developing mouse embryos. In only one human embryo, again to the best of our knowledge, has a channel been found that extends from the aortic sac to the dorsal aorta, and hence qualifies as an arch artery. Despite these confounding factors in terms of the developmental heritage of the fifth arch arteries, the purported channels are invoked with increasing frequency to describe various lesions discovered in the setting of the congenitally malformed heart. Persistence of the artery of the fifth arch was initially proposed to explain double-barrelled aorta. It was subsequently proposed to account for various systemic-to-pulmonary channels feeding the pulmonary circulation in the setting of pulmonary atresia. It has also been claimed to persist so as to explain abnormal branching of the brachiocephalic arteries from the aortic arch. In the light of the ongoing doubts concerning the existence of the arteries of the fifth arch themselves, we have reviewed the various descriptions of purported fifth arch arteries within the world literature. We have then sought to validate the descriptions on the basis of our own understanding of development, for this purpose providing images of the remoulding arch arteries in the mouse so as to substantiate our conclusions. While accepting that our own interpretations are speculative, we suggest that more convincing alternative explanations can be advanced to account for the majority of lesions currently interpreted on the basis of persistence of the arteries of the fifth arches. Although the interpretations do not necessarily change the therapeutic approaches to the channels, appropriate description is important in terms of their classification.

Keywords

Embryologyarterial ductpharyngeal arch arteriesdouble-barrelled aortasystemic-to-pulmonary communicationsbrachiocephalic arteries
Type
Review Article
Information
Cardiology in the Young , Volume 25 , Issue 4 , April 2015 , pp. 628 - 646
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Copyright
© Cambridge University Press 2014 

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References

1. Locy, WA. The fifth and sixth aortic arches in birds and mammals. In: Proceedings of the Seventh International Zoological Congress, Boston, 19–24 August. The University Press, Cambridge, USA, 1907: 242–249.Google Scholar
2. Congdon, ED. Transformation of the aortic arch system during the development of the human embryo. Contrib Embryol 1922; 68: 49–110.Google Scholar
3. Bamforth, SD, Chaudhry, B, Bennett, M, et al. Clarification of the identity of the mammalian fifth pharyngeal arch artery. Clin Anat 2013; 26: 173–182.CrossRefGoogle ScholarPubMed
4. Lorandeau, CG, Hakkinen, LA, Moore, CS. Cardiovascular development and survival during gestation in the Ts65Dn mouse model for down syndrome. Anat Rec 2011; 294: 93–101.CrossRefGoogle ScholarPubMed
5. Geyer, SH, Weninger, WJ. Some mice feature 5th pharyngeal arch arteries and double-lumen aortic arch malformations. Cells Tissues Organs 2012; 196: 90–98.CrossRefGoogle ScholarPubMed
6. Van Praagh, R, Van Praagh, S. Persistent fifth arterial arch in man. Congenital double-lumen aortic arch. Am J Cardiol 1969; 24: 279–282.CrossRefGoogle ScholarPubMed
7. Gerlis, LM, Ho, SY, Anderson, RH, Da Costa, P. Persistent 5th aortic arch – a great pretender: three new covert cases. Int J Cardiol 1989; 23: 239–247.CrossRefGoogle ScholarPubMed
8. Kramer, TC. The partitioning of the truncus and conus and the formation of the membranous portion of the interventricular septum in the human heart. Am J Anat 1942; 71: 343–370.CrossRefGoogle Scholar
9. Sizarov, A, Lamers, WH, Mohun, TJ, Brown, NA, Anderson, RH, Moorman, AF. Three-dimensional and molecular analysis of the arterial pole of the developing human heart. J Anat 2012; 220: 336–349.CrossRefGoogle ScholarPubMed
10. Anderson, RH, Chaudhry, B, Mohun, TJ, et al. Normal and abnormal development of the intrapericardial arterial trunks in humans and mice. Cardiovasc Res 2012; 95: 108–115.CrossRefGoogle ScholarPubMed
11. Hiruma, T, Nakajima, Y, Nakamura, H. Development of pharyngeal arch arteries in early mouse embryo. J Anat 2002; 201: 15–29.CrossRefGoogle ScholarPubMed
12. Graham, A. The development and evolution of the pharyngeal arches. J Anat 2001; 199: 133–141.CrossRefGoogle ScholarPubMed
13. Graham, A. Development of the pharyngeal arches. Am J Med Genet A 2003; 119: 251–256.CrossRefGoogle Scholar
14. Murugan, MK, Gulati, GS, Saxena, A, Juneja, R, Gupta, SK. Multidetector computed tomography (MDCT) in persistent fifth aortic arch (PFAA). Heart, Lung and Circ 2013; 23: e71–e73.CrossRefGoogle ScholarPubMed
15. Macartney, FJ, Scott, O, Deverall, PB. Haemodynamic and anatomical characteristics of pulmonary blood supply in pulmonary atresia with ventricular septal defect – including a case of persistent fifth aortic arch. Br Heart J 1974; 36: 1049–1060.CrossRefGoogle ScholarPubMed
16. Lee, MH, Chiu, CC, Dai, ZK, Lin, WC, Wu, DK, Wu, JR. Type III persistent fifth aortic arch in association with transposition of great arteries and pulmonary atresia – an unreported case. Int J Cardiol 2007; 114: e114–e115.CrossRefGoogle ScholarPubMed
17. Subramanyan, R, Sahayaraj, A, Sekar, P, Cherian, KM. Persistent fifth aortic arch. J Thorac Cardiovasc Surg 2010; 139: e117–e118.CrossRefGoogle ScholarPubMed
18. Freedom, RM, Silver, M, Miyamura, H. Tricuspid and pulmonary atresia with coarctation of the aorta: a rare combination possibly explained by persistence of the fifth aortic arch with a systemic-to-pulmonary arterial connection. Int J Cardiol 1989; 24: 241–245.CrossRefGoogle ScholarPubMed
19. Wu, JR, Chiu, CC, Lin, YT, Huang, TY. Isolated persistent fifth aortic arch with right-sided aortic arch. Jpn Heart J 1995; 36: 813–817.CrossRefGoogle ScholarPubMed
20. Hwang, MS, Chang, YS, Chu, JJ, Su, WJ. Isolated persistent fifth aortic arch with systemic-to-pulmonary arterial connection. J Thorac Cardiovasc Surg 2003; 126: 1643–1644.CrossRefGoogle ScholarPubMed
21. Chiu, CC, Wu, JR, Chen, HM, Lin, YT. Persistent fifth aortic arch: an ignored and underestimated disease. Jpn Heart J 2000; 41: 665–671.CrossRefGoogle ScholarPubMed
22. Holmes, G, Holmes, JL, Berman, W Jr, Yakeb, S. Tetralogy of Fallot with persistent fifth aortic arch: echocardiographic diagnosis. Pediatr Cardiol 2010; 31: 280–282.CrossRefGoogle ScholarPubMed
23. Lee, ML, Chiu, I, Fang, W, Chen, S, Wang, YM, Chaou, WT. Isolated infundibuloarterial inversion and fifth aortic arch in an infant: a newly recognized cardiovascular phenotypes with chromosome 22q11 deletion. Int J Cardiol 1999; 71: 89–91.CrossRefGoogle Scholar
24. Koch, A, Ludwig, J, Zink, S, Singer, H. Isolated left pulmonary artery: interventional stentiong of a persistent fifth aortic arch. Catheter Cardiovasc Interv 2007; 70: 105–109.CrossRefGoogle ScholarPubMed
25. Parmar, RC, Pillai, S, Kulkarni, S, Sivaraman, A. Type I peristsent left fifth aortic arch with truncus arteriosus type A3: an unreported association. Pediatr Cardiol 2004; 25: 432–433.CrossRefGoogle ScholarPubMed
26. Wang, JN, Wu, JM, Yang, YJ. Double lumen aortic arch with anomalous left pulmonary artery origin from the ascending aorta – bilateral persistent fifth aortic arch – a case report. Int J Cardiol 1999; 69: 105–108.CrossRefGoogle ScholarPubMed
27. Lim, C, Kim, WH, Kim, SC, Lee, JY, Kim, SJ, Kim, YM. Truncus arteriosus with coarctation of persistent fifth aortic arch. Ann Thrac Surg 2002; 74: 1702–1704.CrossRefGoogle ScholarPubMed
28. Boothroyd, AE, Smith, A, Peart, I. Persistent fifth aortic arch in association with interruption of the aorta proximal to the brachiocephalic artery. Cardiol Young 1993; 3: 438–440.CrossRefGoogle Scholar
29. Rahme, R, Abruzzo, TA, Ringer, AJ. A completely aberrant aortic arch. J Vasc Surg 2013; 58: 218.CrossRefGoogle ScholarPubMed
30. Natsis, KI, Tsitouridis, IA, Didagelos, MV, et al. Anatomic variations in the branches of the human aortic arch in 663 angiographies: clinical significance and literature review. Surg Radiol Anat 2009; 31: 319–323.CrossRefGoogle Scholar
31. Layton, KF, Kallmes, DF, Cloft, HJ, Lindell, EP, Cox, VS. Bovine aortic arch variant in humans: clarification of a common misnomer. Am J Neuroradiol 2006; 27: 1541–1542.Google ScholarPubMed
32. Nizankowski, C, Rajchel, Z, Ziolkowski, M. Abnormal origin of arteries from the aortic arch in man. Folia Morphol 1975; 34: 109–116.Google ScholarPubMed
33. Moes, CAF, Benson, LN, Burrows, PE, Freedom, RM, Williams, W, Duckworth, JWA. Subclavian artery as the first branch of the aortic arch. Pediatr Cardiol 1991; 12: 39–43.CrossRefGoogle ScholarPubMed
34. Oppido, G, Davies, B. Subclavian artery from ascending aorta or as the first branch of the aortic arch: another variant of persistent fifth aortic arch. J Thrac Cardiovasc Surg 2006; 132: 730–731.CrossRefGoogle ScholarPubMed
35. Boechat, MI, Gilsanz, V, Fellows, KE. Subclavian artery as the first branch of the aortic arch: a normal variant in two patients. Am J Roentgenol 1978; 131: 721–722.CrossRefGoogle ScholarPubMed
36. Hernandez, LE, Shepard, CW, Bamforth, SD, Anderson, RH. The right subclavian artery arising as the first branch of a left-sided aortic arch. World J Pediatr Congenit Heart Surg 2014; 23: 456–459.CrossRefGoogle Scholar
37. Edwards, JE. Anomalies of the derivatives of the aortic arch system. Med Clin North Am 1948; 32: 925–949.CrossRefGoogle ScholarPubMed
38. Lee, ML, Chen, HN, Chen, M, et al. Persistent fifth aortic arch associated with 22q11.2 deletion syndrome. J Formos Med Assoc 2006; 105: 284–289.CrossRefGoogle ScholarPubMed
39. Izukawa, T, Scott, ME, Durrani, F, Moes, CA. Persistent left fifth aortic arch in man. Report of two cases. Br Heart J 1973; 35: 1190–1195.CrossRefGoogle ScholarPubMed
40. Moes, CA, Izukawa, T. Persistent fifth arterial arch. Diagnosis during life, with post-mortem confirmation. Radiology 1974; 111: 175–176.CrossRefGoogle Scholar
41. Lawrence, TY, Stiles, QR. Persistent fifth aortic arch in man. Am J Dis Child 1975; 129: 1229–1231.Google ScholarPubMed
42. Hirano, T, Takeda, H, Yamaguchi, N, Yamazaki, N, Yuasa, H. Double lumen aorta arch due to persistent fifth aortic arch. J Jpn Coll Angiol 1980; 20: 750–753.Google Scholar
43. Diaz-Gongora, G, Quero-Jimenez, M, Varon, H, Cabrera, C, Cabrera, R. Persistencia del quinto arco aortico. Rev Latima Cardiol 1983; 4: 429–434.Google Scholar
44. Carbrera, A, Galdeano, J, Lekuona, I. Persistent left sided fifth aortic arch in a neonate. Br Heart J 1985; 54: 105–106.CrossRefGoogle Scholar
45. Culham, JA, Reed, MH. Persistent fifth aortic arch with corctation of the aorta. Cardiovasc Intervent Radiol 1985; 8: 137–139.CrossRefGoogle Scholar
46. Gerlis, LM, Dickinson, DF, Wilson, N, Gibbs, JL. Persistent fifth aortic arch. A report of two new cases and a review of literature. Int J Cardiol 1987; 16: 185–192.CrossRefGoogle Scholar
47. Herrera, MA, D’Souza, VJ, Link, KM, Formanek, AG. Pediatr Cardiol 1987; 8: 265–269.CrossRefGoogle Scholar
48. Geva, T, Ray, RA, Santini, F, Van Praagh, S, Van Praagh, R. Asymptomatic persistent fifth aortic arch (congenital double lumen aortic arch) in an adult. Am J Cardiol 1990; 65: 1406–1407.CrossRefGoogle ScholarPubMed
49. Gibbin, CL, Midgley, FM, Potter, BM, Martin, GR. Persistent left fifth aortic arch with complex coarctation. Am J Cardiol 1991; 67: 319–320.CrossRefGoogle ScholarPubMed
50. Einzig, S, Steelman, R, Pyles, LA, Balian, A, Millman, E. Radiological case of the month. Persistent left fifth aortic arch in a child without congenital heart disease. Arch Pediatr Adolesc Med 1997; 151: 1259–1260.CrossRefGoogle Scholar
51. Donti, A, Soavi, N, Sabbatani, P, Picchio, FM. Persistent left fifth aortic arch associated with tetralogy of Fallot. Pediatr Cardiol 1997; 18: 229–231.CrossRefGoogle ScholarPubMed
52. Marinho-da-Silva, AJ, Sá-e-Melo, AM, Providência, LA. True double aortic lumen in tetralogy of Fallot. Int J Cardiol 1998; 31: 117–119.CrossRefGoogle Scholar
53. Lambert, V, Blaysat, G, Sidi, D, Lacour-Gayet, F. Double-lumen aortic arch by persistence of fifth aortic arch: a new case associated with coarctation. Pediatr Cardiol 1999; 20: 167–169.CrossRefGoogle ScholarPubMed
54. McMahon, CJ, Kertesz, NJ, Vick, GW. Delineation of persistent fifth aortic arch using magnetic resonance angiography. Cardiol Young 2002; 12: 484–485.CrossRefGoogle ScholarPubMed
55. Yang, SG, Fogel, MA, Stepehns, P Jr, Bellah, RD, Weinberg, PM. Noninvasive imaging of isolated persistent fifth aortic arch. Pediatr Cardiol 2003; 24: 179–181.CrossRefGoogle ScholarPubMed
56. Suda, K, Matsumura, M, Matsumoto, M. Balloon dilation of the stenotic fifth aortic arch in a newborn with double lumen aortic arch. Heart 2004; 90: 245.CrossRefGoogle Scholar
57. Park, HJ, Oh, JM, Park, SE, Nam, SO, Kim, CW, Kim, KI. Isolated persistent fifth aortic arch in a patient with Cornelia de Lange syndrome. Pediatr Cardiol 2005; 26: 112–114.CrossRefGoogle Scholar
58. Baranowska, JA, Sabiniewicz, R, Chojnicki, M, Potaz, P, Erecinski, J, Zapasnik, A. Double lumen aortic arch versus double aortic arch. Folia Cardiol 2006; 13: 164–167.Google Scholar
59. Johnston, T, Farra, H. Double lumen aortic arch in association with tetralogy of Fallot. Images Paediatr Cardiol 2006; 8: 5–7.Google ScholarPubMed
60. Khan, S, Nihil, MR. Clinical presentation of persistent 5th aortic arch: 3 new cases. Tex Heart Inst J 2006; 33: 361–364.Google ScholarPubMed
61. Kirsch, J, Julsrud, PR. Magnetic resonance angiography of an ipsilateral double aortic arch due to persistent left fourth and fifth aortic arches. Pediatr Radiol 2007; 37: 501–502.CrossRefGoogle ScholarPubMed
62. Bernheimer, J, Friedberg, M, Chan, F, Silverman, N. Echocardiographic diagnosis of persistent fifth aortic arch. Echocardiography 2007; 24: 258–262.CrossRefGoogle ScholarPubMed
63. Santoro, G, Caianiello, G, Palladino, MT, Iacono, C, Russo, MG, Calabrò, R. Aortic coarctation with persistent fifth left aortic arch. Int J Cardiol 2009; 136: e33–e34.CrossRefGoogle ScholarPubMed
64. Kligerman, S, Blum, A, Abbara, S. Persistent fifth aortic arch in a patient with a history of intrauterine thalidomide exposure. J Cardiovasc Comput Tomogr 2009; 3: 412–414.CrossRefGoogle Scholar
65. Al Akhfash, AA, Al Mutairi, MB, Al Habshan, FM. Persistent fifth aortic arch diagnosed by echocardiography and confirmed by angiography: case report and literature review. J Saudi Heart Assoc 2009; 21: 245–248.CrossRefGoogle ScholarPubMed
66. Linhares, RR, Silva, CE, Monaco, CG, et al. Double lumen aortic arch or persistence of fifth aortic arch? – Report of a case with no associated cardiac defects and literature review. Echocardiography 2011; 28: E143–E145.CrossRefGoogle ScholarPubMed
67. Khajali, Z, Ali Basiri, H, Maleki, M. Persistent fifth aortic arch associated with coarctation of aorta: a case report. Congenit Heart Dis 2011; 6: 650–652.CrossRefGoogle ScholarPubMed
68. Camarda, JA, Russell, DS, Frommelt, M. Persistent fifth aortic arch: echocardiographic diagnosis of a persistent fifth aortic arch. Echocardiography 2011; 28: E44–E45.CrossRefGoogle ScholarPubMed
69. Tehrai, M, Saidi, B, Goudarzi, M. Multi-detector computed tomography demonstration of double-lumen aortic arch – persistent fifth arch – as an isolated anomaly in an adult. Cardiol Young 2012; 22: 353–355.CrossRefGoogle ScholarPubMed
70. Furtado, AD, Manohar, SR, Pradhan, SK, Pillai, V, Karunakaran, J. Persistent left fifth aortic arch with pentalogy of Fallot. Thorac Cardiovasc Surg 2012; 60: 233–235.Google ScholarPubMed
71. Warrier, D, Shah, S, John, C, Dayananda, L. A rare association with patent ductus arteriosus. Ann Pediatr Cardiol 2012; 5: 191–193.Google ScholarPubMed
72. Yoo, SJ, Moes, CA, Burrows, PE, Molossi, S, Freedom, RM. Pulmonary blood supply by a branch from the distal ascending aorta in pulmonary atresia with ventricular septal defect: differential diagnosis of fifth aortic arch. Pediatr Cardiol 1993; 14: 230–233.CrossRefGoogle ScholarPubMed
73. Fatih, SAP, Altin, H, Karatas, Z, Alp, H, Baysal, T, Karaaslan, S. Persistent fifth aortic arch with systemic-to-pulmonary arterial connection and pulmonary atresia in a neonate. New J Med 2012; 29: 118–120.Google Scholar
74. Jowett, V, Rubens, M, Ho, SY, Uemera, H, Gardiner, HM. Prenatal visualization of persistent 5th aortic arch artery. J Am Coll Cardiol Img 2012; 5: 1288–1289.CrossRefGoogle ScholarPubMed
75. Maeda, M, Kikuchi, T, Kawamura, T, et al. A successful repair of coarctation of the persistent fifth aortic arch. Shinzo (Heart) 1978; 10: 204–208.Google Scholar
76. Anzai, T, Konishi, T, Kawabe, M. Persistent fifth aortic arch left subclavian aneurysm in an adult. Jpn J Surg 1982; 12: 414–418.CrossRefGoogle ScholarPubMed
77. Yoshii, S, Matsukawa, T, Hosaka, S, Ueno, A, Tsuji, A. Repair of coarctation with persistent fifth arterial arch and atresia of the fourth aortic arch. J Cardiovasc Surg (Torino) 1990; 31: 812–814.Google ScholarPubMed
78. Pearl, WR. Single arterial trunk arising from the aortic arch. Evidence that the fifth branchial arch can persist as the definitive aortic arch. Pediatr Radiol 1991; 21: 518–520.CrossRefGoogle ScholarPubMed
79. Da Costa, AG, Iwahashi, ER, Atik, E, Rati, MA, Ebaid, M. Persistence of hypoplastic and recoarcted fifth aortic arch associated with type A aortic arch interruption: surgical and balloon angioplasty results in an infant. Pediatr Cardiol 1992; 13: 104–106.CrossRefGoogle ScholarPubMed
80. Morikawa, M, Nakanishi, K, Nakakwa, H, et al. Two cases of persistent fifth aortic arch in infant and child associated with coarctation of the aorta and atresia of the fourth aortic arch. Acta Cardiol Paed Jpn 1998; 4: 268–275.Google Scholar
81. Tomita, H, Fuse, S, Chiba, S. Coarctation of persistent right fifth aortic arch and pulmonary sequestration. Cardiol Young 1998; 8: 509–511.CrossRefGoogle ScholarPubMed
82. Zartner, P, Schneider, MB, Bein, G. Prostaglandin E1 sensitive persistent fifth aortic arch type 2. Heart 2000; 84: 142.CrossRefGoogle ScholarPubMed
83. Atsumi, N, Moriki, N, Sakakibara, Y, Mitsui, T, Horigome, H, Kamma, H. Persistent fifth aortic arch associated with type A aortic arch interruption. Histological study and morphogenesis. Jpn J Thorac Cardiovasc Surg 2001; 49: 509–512.CrossRefGoogle ScholarPubMed
84. Isomatsu, Y, Takanashi, Y, Terada, M, Kasama, K. Persistent fifth aortic arch and fourth arch interruption in a 28-year-old woman. Pediatr Cardiol 2004; 25: 696–698.CrossRefGoogle ScholarPubMed
85. Iwase, J, Maeda, M, Sasaki, S, Mizuno, A. Images in cardiothoracic surgery. Persistent fifth aortic arch. Ann Thorac Surg. 2006; 81: 1908.CrossRefGoogle ScholarPubMed
86. Ming, Z, Yumin, Z, Yuhua, L, Biao, J, Aimin, S, Qian, W. Diagnosis of congenital obstructive aortic arch anomalies in Chinese children by contrast-enhanced magnetic resonance angiography. J Cardiovasc Magn Reson 2006; 8: 747–753.CrossRefGoogle ScholarPubMed
87. Carroll, SJ, Ferris, A, Chen, J, Liberman, L. Efficacy of prostaglandin E1 in relieving obstruction in coarctation of a persistent fifth aortic arch without opening the ductus arteriosus. Pediatr Cardiol 2006; 27: 766–768.CrossRefGoogle ScholarPubMed
88. Zhao, YH, Su, ZK, Liu, JF, Cao, DF, Ding, WX. Surgical treatment of persistent fifth aortic arch associated with interrupted aortic arch. Ann Thorac Surg 2007; 84: 1016–1019.CrossRefGoogle ScholarPubMed
89. Zhong, Y, Jaffe, RB, Zhu, M, Sun, A, Li, Y, Gao, W. Contrast-enhanced magnetic resonance angiography of persistent fifth aortic arch in children. Pediatr Radiol 2007; 37: 256–263.CrossRefGoogle ScholarPubMed
90. Yu, CH. Persistent fifth aortic arch with coarctation. Pediatr Cardiol 2010; 31: 571.CrossRefGoogle ScholarPubMed
91. Ohashi, N, Sakamoto, T, Kosuka, Y, et al. Persistent fifth aortic arch with coarctation of aorta; report of a case. Kyobu Geka 2012; 65: 158–160.Google ScholarPubMed
92. Inoue, T, Morita, K, Tanaka, K, et al. Distal aortic arch aneurysm associated with persistent fifth aortic arch. Ann Thorac Cardiovasc Surg 2013; http://dx.doi.org/10.5761/atcs.cr.13-00013.Google ScholarPubMed
93. Uysal, F, Bostan, OM, Cil, E. Coarctation of persistent 5th aortic arch: first report of catheter-based intervention. Tex Heart Inst J 2014; 41: 411–413.CrossRefGoogle ScholarPubMed
94. Lee, ML, Tsao, LY, Wang, BT, Lee, MH, Chiu, IS. Maternally inherited unbalanced translocation of chromosome 22 in a 5-day-old neonate with persistent fifth aortic arch and tetralogy of Fallot. Int J Cardiol 2003; 90: 337–339.CrossRefGoogle Scholar