This paper examines the question of the preferred surgical treatment for active infective endocarditis involving the tricuspid valve among intravenous drug users. Two patients are presented: 1) underwent valve excision with concomitant valve bioprosthesis placement with rapid reinfection of the bioprosthesis necessitating its explantation. Redevelopment of congestive heart failure required placement of a second bioprosthesis with good results. The second patient underwent excision only with an asymptomatic state thereafter until the time of his death from overdose 11 months later. The literature is reviewed on this therapeutic dilemma with the conclusion being that excision of the infected tricuspid valve alone is preferable to excision with concurrent prosthetic replacement with the realization that congestive heart failure may make eventual valve prosthesis placement necessary in a subset of patients.