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SURGICAL: Cardiac Valve Procedures with CC

I nfective endocarditis (IE) is an inflammatory process that typically affects a deformed or previously damaged valve, which is usually the focus of the infection. Typically, endocarditis occurs when an invading organism enters the bloodstream and attaches to the leaflets of the valves or the endocardium. Bacteria multiply and sometimes form a projection of tissue that includes bacteria, fibrin, red blood cells, and white blood cells on the valves of the heart. This clump of material, called vegetation, may eventually cover the entire valve surface, leading to ulceration and tissue necrosis. Vegetation may even extend to the chordae tendineae, causing them to rupture and the valve to become incompetent. Most commonly, the mitral or aortic valve is involved. The tricuspid valve is mainly involved in intravenous drug abusers but is otherwise rarely infected. Infections of the pulmonary valve are rare.

IE can occur as an acute or a subacute condition. Generally, acute IE is a rapidly progressing infection, whereas subacute IE progresses more slowly. Acute endocarditis usually occurs on a normal heart valve and is rapidly destructive and fatal in 6 weeks if it is left untreated. Subacute endocarditis usually occurs in a heart already damaged by congenital or acquired heart disease, on damaged valves, and takes up to a year to cause death if it is left untreated.

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