• Pulmonic valve endocarditis (PVE) is a rare complication of infective endocarditis. • It is occasionally associated with significant pulmonic insufficiency (PI). • PVE usually has a benign course, but it can sometimes be complicated. • Doppler and echocardiographic parameters are commonly required to grade the severity of PI. • The decision to manage complicated PVE conservatively versus surgically is challenging.