Infective endocarditis is a major risk for patients with congenital heart disease and has high mortality and morbidity rates, even though there have been many advances in antimicrobial therapy and surgical intervention techniques. Gram positive microorganisms, such as staphylococcus and streptococcus species, are the most commonly isolated organisms. Pseudomonas aeruginosa is a rare causative organism for infective endocarditis. It usually affects the right side of the heart, which is usually seen in intravenous drug users. Incidence of pseudomonas endocarditis has increased due to a higher frequency of drug abuse, heart surgery and bacteremia. Mortality from pseudomonas infective endocarditis remains high despite optimal use of available antibacterial agents and also the treatment plan is very challenging as there is no consensus to date. We report a patient with tetralogy of Fallot and recurrent P. aeruginosa endocarditis after corrective cardiac surgery. We wish to emphasize the importance of surgical intervention and also recall the significance of lenghtening the antipseudomonal combination therapy.