Infective endocarditis is a life-threatening disease with significant morbidity and mortality. Accurate and early diagnosis for initiation of effective treatment is essential in improving patient outcome. Echocardiography is currently the primary modality for the detection of vegetations and cardiac complications that result from endocarditis. Technological advances in echocardiography, particularly the development of transesophageal echocardiography (TEE), have revolutionized the diagnosis and management of infective endocarditis. With the enhanced resolution provided by TEE, vegetations and paravalvular complications can be reliably detected. Transthoracic and transesophageal echocardiography provides complementary information for patient management and follow-up, and is best used in conjunction with clinical data. By means of its high sensitivity and negative predictive value, TEE is essential in the evaluation of prosthetic valve endocarditis and the paravalvular complications of IE. All patients with suspected infective endocarditis should undergo transthoracic echocardiography, and most of these patients should also undergo TEE evaluation. The role of new technology such as harmonic and three-dimensional imaging is yet to be determined.