A 13-year-old girl presented with infective endocarditis of the tricuspid valve related to a residual ventricular septal defect. Antibiotic therapy produced a satisfactory initial improvement, however, subsequent deterioration with uncontrolled infection, in spite of alterations in the antibiotic regime, necessitated surgical intervention. Because the endocarditis was localized to the septal leaflet, management by excision of this leaflet and annuloplasty was possible and resulted in a rapid and sustained clinical improvement with no evidence of significant residual valvar incompetence. The medical management of infective endocarditis requires bacteriological assessment to ensure that the drugs and dosages selected are appropriate and adequate for the causative organism. Early operation may be required for uncontrolled infection or cardiac decompensation; in tricuspid endocarditis secondary to a ventricular septal defect, the operation described permits removal of infective tissue while retaining valvar competence.