VWF and endocarditis: In contrast, in injury-induced endocarditis, such as in rheumatic and congenital valve disease, where turbulent blood flow damages the endothelium, the subendothelium is exposed, resulting in local deposits of fibrin and VWF, to which S. aureus can directly adhere through adhesins such as VWF-binding protein (vWbp) and clumping factor (Clf).