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Case Reports
. 2025 Sep 3;30(26):104921.
doi: 10.1016/j.jaccas.2025.104921.

Elevated Lipoprotein(a) Levels and Massive Ruptured Root and Ascending Aortic Aneurysm

Shubh K Patel  1 , Syed M Ali Hassan  2 , Nitish K Dhingra  3 , Raj Verma  4 , Subodh Verma  5
Affiliations
Case Reports

Elevated Lipoprotein(a) Levels and Massive Ruptured Root and Ascending Aortic Aneurysm

Shubh K Patel et al. JACC Case Rep. .

Abstract

Background: Rupture of a root and ascending aortic aneurysm is a rare, life-threatening condition requiring prompt recognition and surgical intervention. Elevated lipoprotein(a) levels have been implicated in vascular pathology but are less studied in thoracic aneurysms.

Case summary: A 61-year-old man who presented with severe dyspnea and chest tightness was found to have a 7.3-cm ruptured root and ascending aortic aneurysm with elevated lipoprotein(a) (233 nmol/L). He underwent emergency surgery, including a mechanical Bentall procedure, ascending aortic and hemiarch replacement, and bilateral pericardiectomy. At follow-up, he was clinically stable with a well-seated valve conduit and no complications.

Discussion: This case suggests a potential association between elevated lipoprotein(a) and thoracic aortic aneurysm rupture, possibly linked its proatherogenic and proinflammatory properties in vascular pathology. Further investigations are needed to clarify its role in aneurysm risk stratification.

Take-home messages: Elevated lipoprotein(a) may contribute to thoracic aortic aneurysm progression. Its role in risk stratification warrants further investigation.

Keywords: ascending aortic aneurysm; lipoprotein(a); mechanical Bentall procedure.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Dhingra reports statistical support from Amarin, Boehringer Ingelheim, Eli Lilly, Lexicon Pharmaceuticals, and Sanofi. Dr. Verma holds a Tier 1 Canada Research Chair in Cardiovascular Surgery; and reports receiving grants and/or research support and/or speaking honoraria from Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Canadian Heart Research Centre, Canadian Medical and Surgical Knowledge Translation Research Group, Eli Lilly, HLS Therapeutics, Humber River Health, Janssen, Merck, Novartis, Novo Nordisk, Pfizer, PhaseBio, S & L Solutions Event Management Inc, Sanofi, and Sun Pharma. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Preoperative Contrast-Enhanced Computed Tomography (A) Coronal and (B) axial views demonstrating a large ascending aortic aneurysm (7.3 cm) with an associated pericardial effusion (red arrow).
Figure 2
Figure 2
Preoperative Echocardiogram Parasternal long-axis view demonstrating a dilated aortic root and ascending aortic aneurysm (red arrow). The aortic annulus is indicated (blue dotted line).
See this image and copyright information in PMC

References

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