Surgical therapy of infective endocarditis can be undertaken as a prophylactic measure to avoid infection, e.g. in patent ductus arteriosus. In the majority of cases operations are done electively for correction of residual valvular defects ensuing on healed endocarditis. The most challenging problem is cardiac failure in the presence of active infection. While the surgical indication for life-threatening failure is generally recognized, the necessity of early operation, i.e. for acute valvular insufficiency with only mild cardiac failure, is still controverted. Valve replacement to remove a valvular form refractory to antibiotic therapy is less frequently necessary. In fungal endocarditis surgical intervention is recommended as soon as the diagnosis is established. Seven personal cases operated on in the presence of active infection are presented. All survived, but in one patient with fungal endocarditis the infected valve had to be replaced three times before healing was achieved.