akusherstvoObstetrics, Gynecology and ReproductionАкушерство, Гинекология и Репродукция2313-73472500-3194IRBIS LLC10.17749/2313-7347/ob.gyn.rep.2023.444akusherstvo-1823Research ArticleCLINICAL CASEКЛИНИЧЕСКИЙ СЛУЧАЙThe many faces of thrombosis in post-cardiac surgery newbornМноголикость и многообразие тромбозов у новорожденного после операций на сердцеhttps://orcid.org/0000-0001-7673-4762КупряшовА. А.KupryashovA. A.

Купряшов Алексей Анатольевич – д.м.н., зав. отделом клинической и производственной трансфузиологии с диагностической лабораторией

121552 Москва, Рублевское шоссе, д. 135

Alexey A. Kupryashov – MD, Dr Sci Med, Head of the Department of Clinical and Industrial Transfusiology with the Diagnostic Laboratory

135 Rublevskoe Shosse, Moscow 121552

kupriashov2007@rambler.ruhttps://orcid.org/0000-0001-5874-1803ТокмаковаК. А.TokmakovaK. A.

Токмакова Ксения Александровна – к.м.н., старший научный сотрудник отдела клинической и производственной трансфузиологии с диагностической лабораторией

121552 Москва, Рублевское шоссе, д. 135

Ksenia А. Tokmakova – MD, PhD, Senior Researcher, Department of Clinical and Industrial Transfusiology with the Diagnostic Laboratory

135 Rublevskoe Shosse, Moscow 121552

https://orcid.org/0000-0003-0048-4116СамуиловаД. Ш.SamuilovaD. Sh.

Самуилова Дания Шавкетовна – д.б.н., главный научный сотрудник отдела клинической и производственной трансфузиологии с диагностической лабораторией

121552 Москва, Рублевское шоссе, д. 135

Daniya Sh. Samuilova – MD, Dr Sci Biol, Chief Researcher, Department of Clinical and Industrial Transfusiology with the Diagnostic Laboratory

135 Rublevskoe Shosse, Moscow 121552

https://orcid.org/0000-0001-5270-6820ШилкинД. Н.ShilkinD. N.

Шилкин Дмитрий Николаевич – аспирант кафедры сердечно-сосудистой хирургии с курсом аритмологии и клинической электрофизиологии

121552 Москва, Рублевское шоссе, д. 135

Dmitriy N. Shilkin – MD, Postgraduate Student, Department of Cardiovascular Surgery with a Course of Arrhythmology and Clinical Electrophysiology

135 Rublevskoe Shosse, Moscow 121552

ФГБУ «Национальный медицинский исследовательский центр сердечно-сосудистой хирургии имени А.Н. Бакулева» Министерства здравоохранения Российской ФедерацииРоссияBakoulev National Medical Research Center for Cardiovascular Surgery, Health Ministry of Russian FederationRussian Federation202311112023175663669Copyright © Kupryashov A.A., Tokmakova K.A., Samuilova D.S., Shilkin D.N., 20232023Купряшов А.А., Токмакова К.А., Самуилова Д.Ш., Шилкин Д.Н.Kupryashov A.A., Tokmakova K.A., Samuilova D.S., Shilkin D.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.gynecology.su/jour/article/view/1823

We present a clinical case showing the development of two episodes of postoperative thrombosis of varying mechanisms in one patient. The first episode of thrombosis in the systemic-pulmonary anastomosis was due to shear stress-induced secretion and transformation of the von Willebrand factor (vWF) in the performed anastomosis. The altered vWF/ADAMTS-13 (a disintegrin and metalloprotease with thrombospondin type 1 motif, member 13) ratio in favor of the former was accompanied by platelet adhesion and activation in the anastomotic area that resulted in its thrombosis. The second episode of thrombosis within the superior and inferior vena cava was developed in parallel with escalated infectious process and characterized not only by thrombocytopenia, but also by decreased fibrinogen concentration. In this clinical situation, resolution of the infectious process as well as the use of proper antithrombotic therapy led to patient recovery.

На примере одного пациента показано развитие двух эпизодов послеоперационных тромбозов, имеющих различные механизмы. Тромбоз системно-легочного анастомоза был обусловлен индуцированной напряжением сдвига секрецией и трансформацией фактора фон Виллебранда (англ. von Willebrand factor, vWF) на участке выполненного соустья. Изменение соотношения vWF/ADAMTS-13 (англ. a disintegrin and metalloprotease with thrombospondin type 1 motif, member 13) в пользу vWF сопровождалось адгезией и активацией тромбоцитов в области анастомоза и привело к его тромбозу. Второй эпизод тромбоза с локализацией в системах верхней и нижней полых вен развился на фоне эскалации инфекционного процесса и характеризовался не только тромбоцитопенией, но и снижением концентрации фибриногена. В данной клинической ситуации разрешение инфекционного процесса, а также применение адекватной антитромботической терапии привело к выздоровлению.

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The authors declare that there are no conflicts of interest present.