A 46-year old female with a history of intravenous drug abuse underwent two surgical tricuspid valve (TV) replacement procedures for recurrent infective endocarditis (IE), the latter with a 29 mm Carpentier-Edwards Perimount Magna bioprosthesis, complicated by sternal osteomyelitis. After a further episode of IE treated with antibiotics she developed progressive effort dyspnea and presented to our hospital after a six-month rehabilitation program for drug abusers on methadone maintenance treatment.