A patient with enterococcal endocarditis of 11 months' duration is presented, and the role of surgery and echocardiography is reviewed. Echocardiography revealed vegetations of the aortic and mitral valves. After appropriate antibiotic therapy the patient had successful aortic and mitral valve replacement with porcine heterografts. Enterococcal endocarditis is increasing in frequency and is likely to infect young women of childbearing age, elderly men who have had genitourinary tract manipulation, and abusers of intravenous drugs. Aortic and mitral valves are most frequently affected, cardiac failure is common, and often no evidence of underlying heart disease can be found. The use of echocardiography in this patient provided accurate diagnosis of valvular vegetations and assessment of the hemodynamic severity of the lesion, thus preventing the need for cardiac catheterization and its potential risk of septic embolization.