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Introduction: Infective endocarditis (IE) is a rare condition in children which is associated with significant morbidity and mortality. While IE affects most often patients with underlying congenital heart defects (CHD) - corrected or unrepaired, the disease can also occur in patients with structurally normal hearts having most often predisposing conditions such as prematurity, chronic illnesses, immunosuppression, and central venous lines. Objective: Our study aims to analyze the features of IE in children with structurally normal hearts. Materials and Methods: The study is retrospective and includes the data of six patients aged <18 years with IE and structurally normal hearts who were treated at the department of the National Heart Hospital - Sofia, for the period 01.01.2009- 31.12.2022. The demographic characteristics, predisposing conditions, clinical presentation, investigations results, therapeutic approach, and clinical outcome were assessed. Results: The mean age of the patients is 3.5 years (12 days to 9 years, SD 2.9), the diagnosis IE was based on the modified Duke criteria. Fever was the predominant symptom, followed by fatigue and neurological symptoms. All children had increased C-reactive protein; in five patients, a microbiological agent was isolated from blood cultures, while in one case, the cultures remained negative because of prior antibiotic treatment. Surgery was needed in three children, with valve replacement in two of them. There was one IE relapse and one lethal outcome. Conclusion: Although more common in patients with CHD, the diagnosis of IE should be considered in all children with fever of unknown origin, even in the absence of an underlying heart disease. Obtaining blood cultures before initiating antibiotic treatment is crucial for early identification of the IE causative agent and determining the optimal antibiotic therapy. [ABSTRACT FROM AUTHOR]