Sydney, an 18-year-old woman with congenital heart disease (CHD), had infective endocarditis and was admitted in critical condition to the cardiac intensive care unit (CICU) at a pediatric medical center, where she has been followed since birth because of the CHD. As an infant she had a right ventricle–dominant atrioventricular (AV) canal defect, which was repaired when she was 4 months old. Persistent AV valve insufficiency resulted in the need to replace her left AV valve when she was 18 months of age. Sydney subsequently underwent 2 additional valve replacement procedures, the last of which was performed when she was 14 years old. Since that surgery, Sydney’s cardiac function has remained stable, and she is seen in the cardiology clinic for annual routine follow-ups. Two days before this most recent admission, however, Sydney was brought to the emergency department by emergency medical services;...

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