vegetations appear on the aortic cusps during acute rheumatic fever
following the acute valvulitis there is fibrotic shrinkage, causing aortic regurgitation and stenosis
congenital:
often the valve is bicuspid as well as deficient
sometimes a ventricular septal defect may cause prolapse of the associated cusp
infective endocarditis:
usually occurs on an abnormal valve
occasionally a normal valve is the site of an infection in either older patients with degenerative changes, drug addicts or with infection with virulent organisms e.g. staphylococcus
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