Neonatal Repair of Persistent Fifth Aortic Arch Coarctation and Interrupted Fourth Aortic Arch.

Persistent left fifth aortic arch is a rare anomaly often associated with aortic coarctation. We report the case of a newborn presenting with signs of duct-dependent aortic coarctation. Echocardiography showed an interrupted fourth aortic arch, persistent left fifth aortic arch associated with aortic coarctation, and a restrictive arterial duct. Arch repair was accomplished using the fifth aortic arch as an in situ flap to enlarge the hypoplastic fourth aortic arch associated with coarctectomy and extended end-to-end anastomosis. We believe that this newly reported surgical approach is safe and effective and allows for adequate enlargement of the entire fourth aortic arch.