Figure 5. Putative scenario for IE.

The natural history of IE may be decomposed in successive steps including cell apoptosis that may be promoted by blood turbulence in the vicinity of valve lesion (A), procoagulant activity that results in fibrin and platelet deposition (B), bacterial colonization and chemoattraction of neutrophils increasing vegetation size (C), tissue remodelling and neoangiogenesis leading to the functional destruction of the valve (D). At this stage, the situation is irreversible and cardiac surgery is necessary.