With recent advances in technology, echocardiography has not only been proven to play a dramatic and exciting role in the diagnosis and management of infective endocarditis, but in addition, is providing new insights into the natural history of the vegetation. Since the first vegetation was described by M-mode echocardiography almost 20 years ago, refinements in color Doppler and the addition of transesophageal imaging have allowed more accurate detection of vegetations, including the complications produced involving abnormalities of the valvular and supporting cardiac structures, as well as the resultant alterations in cardiac hemodynamics. With this new information, which is now widely and readily available through echocardiography, a significant impact should be made on the morbidity and mortality of infectious endocarditis in the ensuing years.