Surviving All Odds: A Unique Case of Multiple Congenital Unruptured Sinus of Valsalva Aneurysms Involving Both Left and Right Coronary Sinuses with Biventricular Dysfunction and Heart Block

<div>Transesophageal <svg height="13.6886pt" id="M1" style="vertical-align:-3.3838pt" version="1.1" viewbox="-0.0498162 -10.3048 99.9469 13.6886" width="99.9469pt" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink"><g transform="matrix(.013,0,0,-0.013,0,0)"><path d="M380 106C343 72 306 56 265 56C195 56 116 112 115 248C235 252 361 262 377 265C396 269 400 277 400 297C400 374 333 449 250 449H249C198 449 144 421 103 376S37 269 37 201C37 88 109 -12 232 -12C263 -12 332 6 395 84L380 106ZM225 412C281 412 315 364 314 312C314 297 308 292 290 292C232 290 176 289 120 289C135 370 180 412 225 412Z" id="g121-99"></path><glyph.data ascent="989" descent="-360" horiz-adv-x="425" vert-adv-y="425"></glyph.data></g><g transform="matrix(.013,0,0,-0.013,5.59,0)"><path d="M390 111C344 68 312 56 269 56C212 56 118 102 118 241C118 346 175 401 241 401C277 401 312 388 342 360C350 352 355 349 361 349C372 349 394 371 394 392C394 403 391 411 378 422C362 436 329 449 288 449H287C250 449 190 432 138 392C71 341 37 274 37 197C37 90 112 -12 238 -12C297 -12 363 32 407 90L390 111Z" id="g121-97"></path><glyph.data ascent="989" descent="-360" horiz-adv-x="423" vert-adv-y="423"></glyph.data></g><g transform="matrix(.013,0,0,-0.013,11.011,0)"><path d="M513 0V26C455 31 447 37 447 103V278C447 398 390 449 309 449C255 449 202 412 166 376V712C127 700 67 684 19 677V653C85 647 87 643 87 580V103C87 37 79 31 19 26L18 0H231V26C171 32 166 39 166 103V341C194 373 232 392 270 392C337 392 368 351 368 269V103C368 38 360 32 302 26V0H513Z" id="g121-102"></path><glyph.data ascent="989" descent="-360" horiz-adv-x="534" vert-adv-y="534"></glyph.data></g><g transform="matrix(.013,0,0,-0.013,17.901,0)"><path d="M257 449C165 449 37 374 37 209C37 98 119 -12 256 -12C355 -12 473 65 473 226C473 349 381 449 257 449ZM244 416C333 416 380 320 380 204C380 67 329 21 267 21C184 21 130 115 130 241C130 354 184 416 244 416Z" id="g121-109"></path><glyph.data ascent="989" descent="-360" horiz-adv-x="510" vert-adv-y="510"></glyph.data></g><g transform="matrix(.013,0,0,-0.013,24.648,0)"><path d="M390 111C344 68 312 56 269 56C212 56 118 102 118 241C118 346 175 401 241 401C277 401 312 388 342 360C350 352 355 349 361 349C372 349 394 371 394 392C394 403 391 411 378 422C362 436 329 449 288 449H287C250 449 190 432 138 392C71 341 37 274 37 197C37 90 112 -12 238 -12C297 -12 363 32 407 90L390 111Z" id="g121-97"></path><glyph.data ascent="989" descent="-360" horiz-adv-x="423" vert-adv-y="423"></glyph.data></g><g transform="matrix(.013,0,0,-0.013,30.186,0)"><path d="M433 39L423 65C413 59 399 54 387 54C370 54 352 69 352 114V299C352 352 342 392 307 422C285 440 255 449 225 449C168 437 102 399 75 379C56 365 44 353 44 339C44 315 69 296 87 296C101 296 111 303 116 319C124 349 133 371 145 385C156 397 171 404 190 404C241 404 275 364 275 291V274C253 256 180 229 120 209C65 190 39 159 39 110C39 47 88 -12 159 -12C189 -12 237 25 277 52C282 35 288 21 301 8C312 -3 333 -12 348 -12L433 39ZM275 84C256 65 221 48 195 48C164 48 124 73 124 124C124 161 146 180 185 198C206 208 254 229 275 240V84Z" id="g121-95"></path><glyph.data ascent="989" descent="-360" horiz-adv-x="439" vert-adv-y="439"></glyph.data></g><g transform="matrix(.013,0,0,-0.013,35.776,0)"><path d="M181 342V451C133 431 89 419 40 411V388C98 381 102 377 102 311V104C102 38 95 32 33 26V0H263V26C186 32 181 38 181 104V287C203 343 235 372 261 372C277 372 289 366 304 352C310 346 318 345 330 350C349 359 362 379 362 399C362 422 338 449 304 449C256 449 213 393 183 342H181Z" id="g121-112"></path><glyph.data ascent="989" descent="-360" horiz-adv-x="371" vert-adv-y="371"></glyph.data></g><g transform="matrix(.013,0,0,-0.013,40.429,0)"><path d="M517 51L485 54C448 58 441 63 441 115V712C404 700 337 684 285 678V653C357 648 362 645 362 580V437C339 446 309 449 295 449C159 449 38 340 38 201C38 61 143 -12 223 -12C234 -12 261 -6 301 17L362 53V-12C420 9 495 22 517 26V51ZM362 85C338 67 301 51 266 51C201 51 128 109 128 228C128 373 212 411 259 411C296 411 338 395 362 360V85Z" id="g121-98"></path><glyph.data ascent="989" descent="-360" horiz-adv-x="528" vert-adv-y="528"></glyph.data></g><g transform="matrix(.013,0,0,-0.013,47.293,0)"><path d="M135 536C164 536 186 560 186 587C186 617 164 639 136 639C109 639 85 617 85 587C85 560 109 536 135 536ZM252 0V26C188 32 181 38 181 106V451C138 433 90 420 39 412V388C99 379 102 374 102 312V106C102 38 95 32 32 26V0H252Z" id="g121-103"></path><glyph.data ascent="989" descent="-360" horiz-adv-x="268" vert-adv-y="268"></glyph.data></g><g transform="matrix(.013,0,0,-0.013,50.777,0)"><path d="M257 449C165 449 37 374 37 209C37 98 119 -12 256 -12C355 -12 473 65 473 226C473 349 381 449 257 449ZM244 416C333 416 380 320 380 204C380 67 329 21 267 21C184 21 130 115 130 241C130 354 184 416 244 416Z" id="g121-109"></path><glyph.data ascent="989" descent="-360" horiz-adv-x="510" vert-adv-y="510"></glyph.data></g><g transform="matrix(.013,0,0,-0.013,57.407,0)"><path d="M463 437C426 431 375 425 327 422C297 440 264 449 231 449H230C153 449 51 396 51 283C51 215 94 168 139 149C123 129 91 103 51 88C50 78 53 60 62 46C75 25 100 2 136 -9C112 -28 73 -59 53 -79C38 -94 29 -113 29 -135C30 -192 91 -257 203 -257C336 -257 452 -160 452 -59C452 39 371 59 309 59C275 59 240 58 203 58C158 58 140 77 140 96C140 110 157 129 170 138C186 135 205 133 221 133C306 133 396 185 396 293C396 328 384 360 366 381L423 378C439 387 459 413 468 429L463 437ZM219 418C277 418 314 362 314 284C314 205 275 166 231 165C176 165 137 221 137 299C137 376 177 418 219 418ZM241 -11C285 -11 314 -14 339 -24C367 -36 384 -61 384 -95C384 -157 335 -206 240 -206C166 -206 108 -165 108 -110C108 -82 128 -54 154 -32C172 -17 195 -11 241 -11Z" id="g121-101"></path><glyph.data ascent="989" descent="-360" horiz-adv-x="468" vert-adv-y="468"></glyph.data></g><g transform="matrix(.013,0,0,-0.013,63.557,0)"><path d="M181 342V451C133 431 89 419 40 411V388C98 381 102 377 102 311V104C102 38 95 32 33 26V0H263V26C186 32 181 38 181 104V287C203 343 235 372 261 372C277 372 289 366 304 352C310 346 318 345 330 350C349 359 362 379 362 399C362 422 338 449 304 449C256 449 213 393 183 342H181Z" id="g121-112"></path><glyph.data ascent="989" descent="-360" horiz-adv-x="371" vert-adv-y="371"></glyph.data></g><g transform="matrix(.013,0,0,-0.013,68.38,0)"><path d="M433 39L423 65C413 59 399 54 387 54C370 54 352 69 352 114V299C352 352 342 392 307 422C285 440 255 449 225 449C168 437 102 399 75 379C56 365 44 353 44 339C44 315 69 296 87 296C101 296 111 303 116 319C124 349 133 371 145 385C156 397 171 404 190 404C241 404 275 364 275 291V274C253 256 180 229 120 209C65 190 39 159 39 110C39 47 88 -12 159 -12C189 -12 237 25 277 52C282 35 288 21 301 8C312 -3 333 -12 348 -12L433 39ZM275 84C256 65 221 48 195 48C164 48 124 73 124 124C124 161 146 180 185 198C206 208 254 229 275 240V84Z" id="g121-95"></path><glyph.data ascent="989" descent="-360" horiz-adv-x="439" vert-adv-y="439"></glyph.data></g><g transform="matrix(.013,0,0,-0.013,73.839,0)"><path d="M169 380V459C122 440 66 423 24 416V392C86 384 90 382 90 317V-135C90 -201 81 -207 17 -213V-240H253V-213C176 -207 169 -201 169 -125V6C182 -1 208 -11 238 -12C368 12 487 109 487 260C487 358 421 449 310 449C298 449 279 444 261 433L169 380ZM169 346C196 367 237 389 269 389C341 389 403 329 403 221C403 109 347 37 263 37C228 37 191 53 169 76V346Z" id="g121-110"></path><glyph.data ascent="989" descent="-360" horiz-adv-x="524" vert-adv-y="524"></glyph.data></g><g transform="matrix(.013,0,0,-0.013,80.559,0)"><path d="M513 0V26C455 31 447 37 447 103V278C447 398 390 449 309 449C255 449 202 412 166 376V712C127 700 67 684 19 677V653C85 647 87 643 87 580V103C87 37 79 31 19 26L18 0H231V26C171 32 166 39 166 103V341C194 373 232 392 270 392C337 392 368 351 368 269V103C368 38 360 32 302 26V0H513Z" id="g121-102"></path><glyph.data ascent="989" descent="-360" horiz-adv-x="534" vert-adv-y="534"></glyph.data></g><g transform="matrix(.013,0,0,-0.013,87.201,0)"><path d="M478 437H297V411C355 404 361 392 349 355C329 292 285 174 257 106L167 356C153 394 158 404 205 411L204 437H2V411C57 404 66 391 88 336C117 265 162 144 202 30C208 13 209 0 204 -15C199 -28 191 -49 173 -84C149 -128 130 -153 98 -172C81 -184 73 -193 73 -209C73 -233 101 -257 129 -257C143 -257 156 -252 161 -232C175 -179 197 -122 264 38C333 203 364 286 390 339C417 395 425 403 478 411V437Z" id="g121-119"></path><glyph.data ascent="989" descent="-360" horiz-adv-x="459" vert-adv-y="459"></glyph.data></g><g transform="matrix(.0091,0,0,-0.0091,93.768,-5.944)"><path d="M486 158C486 177 478 202 466 220C413 228 386 236 336 262C386 288 413 297 466 304C478 323 486 347 485 366C470 376 444 381 422 380C389 338 368 319 321 288C323 345 329 372 349 422C339 442 322 461 305 470C289 461 271 442 262 422C281 372 287 345 290 288C243 319 222 338 189 380C167 381 142 376 125 366C125 347 133 322 145 304C198 296 225 288 275 262C225 236 198 227 145 220C133 201 125 177 126 158C141 148 167 143 189 144C222 186 243 205 290 236C288 179 282 152 262 102C272 82 289 63 306 54C322 63 340 82 350 102C330 152 324 179 321 236C368 205 390 186 422 144C444 143 470 148 486 158Z" id="g50-43"></path><glyph.data ascent="3443" descent="-2856" horiz-adv-x="611" vert-adv-y="611"></glyph.data></g></svg> revealed left sinus of Valsalva aneurysm with thrombus within it causing RVOT obstruction. <svg height="13.9365pt" id="M2" style="vertical-align:-3.834pt" version="1.1" viewbox="-0.0498162 -10.1025 39.3877 13.9365" width="39.3877pt" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink"><g transform="matrix(.0091,0,0,-0.0091,0,-5.741)"><path d="M486 158C486 177 478 202 466 220C413 228 386 236 336 262C386 288 413 297 466 304C478 323 486 347 485 366C470 376 444 381 422 380C389 338 368 319 321 288C323 345 329 372 349 422C339 442 322 461 305 470C289 461 271 442 262 422C281 372 287 345 290 288C243 319 222 338 189 380C167 381 142 376 125 366C125 347 133 322 145 304C198 296 225 288 275 262C225 236 198 227 145 220C133 201 125 177 126 158C141 148 167 143 189 144C222 186 243 205 290 236C288 179 282 152 262 102C272 82 289 63 306 54C322 63 340 82 350 102C330 152 324 179 321 236C368 205 390 186 422 144C444 143 470 148 486 158Z" id="g50-43"></path><glyph.data ascent="3443" descent="-2856" horiz-adv-x="611" vert-adv-y="611"></glyph.data></g><g transform="matrix(.013,0,0,-0.013,6.079,0)"><path d="M673 0V28C608 34 594 43 563 129C499 303 432 494 370 665L339 656L132 132C98 43 84 37 20 28V0H238V28C162 35 154 45 175 108C188 150 203 192 219 237H432C454 176 474 122 487 83S491 36 428 28V0H673ZM418 280H234C265 362 296 450 328 535H330L418 280Z" id="g121-63"></path><glyph.data ascent="989" descent="-360" horiz-adv-x="691" vert-adv-y="691"></glyph.data></g><g transform="matrix(.013,0,0,-0.013,14.723,0)"><path d="M257 449C165 449 37 374 37 209C37 98 119 -12 256 -12C355 -12 473 65 473 226C473 349 381 449 257 449ZM244 416C333 416 380 320 380 204C380 67 329 21 267 21C184 21 130 115 130 241C130 354 184 416 244 416Z" id="g121-109"></path><glyph.data ascent="989" descent="-360" horiz-adv-x="510" vert-adv-y="510"></glyph.data></g><g transform="matrix(.013,0,0,-0.013,21.196,0)"><path d="M181 342V451C133 431 89 419 40 411V388C98 381 102 377 102 311V104C102 38 95 32 33 26V0H263V26C186 32 181 38 181 104V287C203 343 235 372 261 372C277 372 289 366 304 352C310 346 318 345 330 350C349 359 362 379 362 399C362 422 338 449 304 449C256 449 213 393 183 342H181Z" id="g121-112"></path><glyph.data ascent="989" descent="-360" horiz-adv-x="371" vert-adv-y="371"></glyph.data></g><g transform="matrix(.013,0,0,-0.013,26.15,0)"><path d="M298 36L289 62C276 55 253 45 228 45C202 45 169 60 169 141V397H276C289 405 292 426 282 437H169V574L155 576L90 509V437H45L17 408L21 397H90V107C90 28 125 -12 188 -12C198 -12 213 -8 230 1L298 36Z" id="g121-114"></path><glyph.data ascent="989" descent="-360" horiz-adv-x="305" vert-adv-y="305"></glyph.data></g><g transform="matrix(.013,0,0,-0.013,30.18,0)"><path d="M135 536C164 536 186 560 186 587C186 617 164 639 136 639C109 639 85 617 85 587C85 560 109 536 135 536ZM252 0V26C188 32 181 38 181 106V451C138 433 90 420 39 412V388C99 379 102 374 102 312V106C102 38 95 32 32 26V0H252Z" id="g121-103"></path><glyph.data ascent="989" descent="-360" horiz-adv-x="268" vert-adv-y="268"></glyph.data></g><g transform="matrix(.013,0,0,-0.013,33.664,0)"><path d="M390 111C344 68 312 56 269 56C212 56 118 102 118 241C118 346 175 401 241 401C277 401 312 388 342 360C350 352 355 349 361 349C372 349 394 371 394 392C394 403 391 411 378 422C362 436 329 449 288 449H287C250 449 190 432 138 392C71 341 37 274 37 197C37 90 112 -12 238 -12C297 -12 363 32 407 90L390 111Z" id="g121-97"></path><glyph.data ascent="989" descent="-360" horiz-adv-x="423" vert-adv-y="423"></glyph.data></g></svg> valve long-axis view at midesophageal level.</div>

Case Reports in Cardiology

fig1

Figure 1

Figure 1: Surviving All Odds: A Unique Case of Multiple Congenital Unruptured Sinus of Valsalva Aneurysms Involving Both Left and Right Coronary Sinuses with Biventricular Dysfunction and Heart Block 

Figure 1 | Surviving All Odds: A Unique Case of Multiple Congenital Unruptured Sinus of Valsalva Aneurysms Involving Both Left and Right Coronary Sinuses with Biventricular Dysfunction and Heart Block 