A general misconception that unicuspid aortic valves (UAV) are just a subtype of bicuspid aortic valves (BAV) has now been perpetuated in the medical and surgical community for nearly two decades[1](#ref-0001), and there is no end in sight.

Caseous liquefaction necrosis of mitral annular calcifications are rare. Rupture of its capsule may lead to systemic embolization. Surgical management entails Incision and Drainage with either mitral valve repair or replacement.

Unicuspid aortic valves are rare congenital malformations. Surgical repair is feasible in aortic regurgitation, and in some cases of aortic stenosis. The standard surgical approach is a bicuspidization and symmetrization with pericardial patch augmentation of valve cusps. Herein, we are describing our original technique for bicuspidization of a unicuspid aortic valve without cusp patch augmentation. We also address the surgical management of a commissural diastasis.

Aortic valve and root replacements require an in-depth understanding of the aortic root and annulus. Both structures can be asymmetric at times, and this needs to be recognized and taken into consideration when peforming valve-sparing operations or other root-replacement procedures. Moreover, the geometry of the aortic annulus can be altered, and when performing an aortic root replacement this can distort the geometry of a neo-aortic valve for instance, and lead to valve dysfunction, which is difficult to reverse. We are describing an altered aortic annulus, which required modification through annulus elevation before proceeding with aortic root replacement with a graft-reinforced pulmonary-autograft.

Many authors have reported their results of mitral valve (MV) repair1,2 in acute and healed endocarditis. However, the results published from different authors highlight the fact that the reparability rate for this indication remains low. Over the last 3 decades our group has adopted an early and repair-oriented approach to the infective endocarditis with the objective to improve the repair rate and the long-term results.‬ ‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬ In this paper we describe our institutional experience on mitral valve repair for infective endocarditis.‬‬‬‬‬‬‬‬‬ Data for this paper were extracted from our institutional database on heart valve disease. From 1991 to 2015, 160 consecutive patients in our institution underwent MV surgery for active IE on native MV. The median follow-up was 122 months. This study was approved by the institutional ethics review board, and written informed consent was waived for this study given its retrospective design. Hospital mortality was 11.6 % (n = 18). Early MV reoperation before hospital discharge was required in 5 (3.1%) patients. At 5, 10 and 15 years, overall survival in the MVr for endocarditis in group was 79 ± 4%, 65 ± 5%, 57 ± 6%, respectively. Freedom from reoperation at 5, 10 and 15 years was 95 ± 2%, 88 ± 4% and 81 ± 6%, respectively. Mitral infective endocarditis is an insidious pathology and his surgical approach can be challenging. An early and repair-oriented surgical approach can allow to improve reparability rates with good long-term durability and a low recurrence rate of endocarditis.