The many faces of thrombosis in post-cardiac surgery newborn

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.