Standard M mode echocardiography and a new real time two dimensional echocardiographic imaging system were utilized to follow the progressive anatomic destruction of the tricuspid valve in a patient with bacterial endocarditis. The initial two dimensional echocardiographic study revealed large vegetative masses attached to severely prolapsing tricuspid leaflets. Serial studies demonstrated eventual disruption of the chordal attachments of the anterior tricuspid leaflet resulting in frank leaflet flail. This technique was seen to complement both M mode echocardiography and cardiac angiography by providing spatial information concerning serial changes in the disordered tricuspid valve. Such findings call attention to the relative roles of various diagnostic measures, including M mode and two dimensional echocardiography, in assessing the specific anatomic and functional performance of a diseased tricuspid valve.