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small aortic annulus in children guideline for treating small aortic root treatment of small aortic annulus small aortic annulus aortic valve pathology aortic valve stenosis echocardiography aortic valve stenosis symptoms aortic valve stenosis treatment aortic valve stenosis guideline aortic valve stenosis pathophysiology cardiothoracic surgery thoracic surgery sternal defects sternal cleft asphyxiating thoracic dystrophy jeune鈥檚 syndrome poland鈥檚 syndrome ravitch procedure ectopia cordis pectus carinatum pectus excavatum