Infective endocarditis (IE) is an infection involving the cardiac endothelial surfaces. In suspected endocarditis, transesophageal echocardiography (TEE) will usually follow a transthoracic (TTE) examination. Aortic valve vegetations are attached to the ventricular surface of the valve leaflets, and may be seen in the aortic root in systole and in the left ventricular outflow tract (LVOT) in diastole. The risk of embolization of a vegetation increases with the size of vegetations. Regurgitant lesions in valves affected by endocarditis occur because of tissue destruction by the disease process itself, and because of distortion of structures by vegetations. Perivalvular abscess formation is more common with prosthetic than with native-valve endocarditis, because the infection typically involves the interface between the sewing ring and the surrounding tissue. Prosthetic-valve endocarditis that relapses after appropriate antibiotic therapy should lead to a careful search for perivalvular extension and metastatic foci of infection.