ANOMALOUS LEFT MAIN CORONARY ARTERIES ARISING FROM THE RIGHTSINUS OF VALSALVA WITH A PREPULMONIC COURSE: EMBRYOLOGICALINSIGHTS, GEOMETRIC HAZARDS IN INTERVENTIONAL CARDIOLOGY,ADVANCED FLUID DYNAMICS

VOLUME - 15, ISSUE - 08, AUGUST - 2026 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra https://www.worldwidejournals.com/global-journal-for-research-analysis-GJRA/file.php?val=anomalous-left-main-coronary-arteries-arising-from-the-right-sinus-of-valsalva-with-a-prepulmonic-course-embryological-insights-geometric-hazards-in-interventional-cardiology_August_2026_8318080617_6811479.pdf

Anomalous aortic origin of a coronary artery (AAOCA), specifically the anomalous left main coronary artery (LMCA) arising from the right sinus of Valsalva (RSV), represents a rare but clinically profound spectrum of congenital cardiovascular disease. While some anomalies carry the highest risk of sudden cardiac death (SCD), the prepulmonic variant presents unique, distinct hazards. This comprehensive review examines the embryological deviations in peritruncal ring cushion migration and vascular endothelial growth factor (VEGF)/fibroblast growth factor (FGF) signalling that precipitate this anomaly. We dissect the specific geometric constraints that make percutaneous coronary intervention (PCI) exceptionally difficult, focusing on the coaxial misalignment between the left circumflex (LCx) artery and the LMCA, alongside the acute-angle take-off of the left anterior descending (LAD) artery. Furthermore, we analyze the advanced fluid dynamics—characterized by high oscillatory shear index (OSI) and reduced time-averaged wall shear stress (TAWSS)—that accelerate asymmetric atherogenesis within these vessels. Diagnostic distinction from mimics such as a hypertrophied conus branch, arterial rings of Vieussens, and single coronary variants (Lipton Type R-II/R-III) is detailed. Finally, we critique therapeutic paradigms, outlining why the left internal mammary artery (LIMA) is an unfavorable conduit, and establishing the superiority of surgical unroofing or anatomical translocation over traditional bypass grafting