Aiming to know the principal anatomo-pathological findings in patients that died with a diagnosis of infective endocarditis, the clinical histories and necropsy protocols of such patients that died between 1984 and 1989 were reviewed. Twenty patients (11 male) aged 43.2 +/- 16.1 years were studied. In nine, the endocarditis was subacute, and 80% had a history of valvular or congenital heart disease. The principal clinical complication was sepsis followed by neurological, nephrological and cardiac complications. The necropsy disclosed cardiac, nephrological and abdominal lesions in 100, 80 and 65% of patients respectively. In 65% of necropsies, neurological injuries were found (cerebral edema in 7 patients and hemorrhagic complications in 11). It is concluded that extra cardiac lesions are frequent in patients dying with a diagnosis of infective endocarditis.