Between January 1987 and June 2004, 65 patients with infective endocarditis underwent aortic and/or mitral surgery. Nine of these patients with active native valve endocarditis required emergency surgery. Indications for emergency operation were progressive congestive heart failure in 5 patients, systemic emboli in 2 patients and uncontrolled infection in 2 patients. The aortic valve was affected in 3 patients, the mitral valve in 4 patients and both the aortic and mitral valve in 2 patients. All of these patients were treated with radical excision of infected tissue and implantation of mechanical or stented bioprosthetic valves. There was no hospital death and no patients required reoperation for recurrent endocarditis. Although medical therapy for acute infective endocarditis is effective in most instances, some patients still require early surgical intervention. These data demonstrate excellent results in patients who underwent emergency surgery for acute infective endocarditis.