The results of 100 patients with primary active infective endocarditis treated surgically are presented. Hospital and late mortalities as well as postoperative complications in patients operated electively and not showing paravalvular infection approach those of routine procedures while frank circulatory failure and uncontrolled sepsis were associated with high death and complication rates. Paravalvular extension of the infection was associated with frequent postoperative leakage, reoperations and mortality. The present operative choices in eradicating paravalvular disease are described and the great importance of early operation is stressed.