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Htut N, Tzeng IS, Fan YJ, Cheng YL. Body measurement changes in adults with pectus excavatum after the Nuss procedure: a study of 272 patients. J Cardiothorac Surg 2024; 19:65. [PMID: 38321519 PMCID: PMC10845464 DOI: 10.1186/s13019-024-02573-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 01/30/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Pectus excavatum (PE) is the most common congenital abnormality of the chest wall. Most patients with PE have slim bodies. Some studies have been conducted on the physical growth of children and adolescents who underwent the Nuss procedure. This study aimed to evaluate body measurement changes in adult patients with PE after the Nuss procedure. METHODS A total of 272 adult PE patients, who underwent the Nuss procedure and pectus bars removal from August 2014 to December 2020, were evaluated retrospectively. Body measurement [body height (BH), body weight (BW), and body mass index (BMI)] of the patients were collected before Nuss repair and after bar removal. We used the interquartile range (IQR) to identify and exclude outliers. Associations between changes in body measurement and clinical and radiological features were evaluated. RESULTS The BH, BW and BMI showed significantly increased after pectus bar removal, compared to pre-Nuss procedure parameters (BH 173.8 ± 5.9 cm vs. 173.9 ± 5.9 cm, P < 0.001; BW 60.3 ± 8.1 kg vs. 61.1 ± 8.8 kg, P = 0.005; BMI 19.9 ± 2.2 kg/m2 vs. 20.1 ± 2.4 kg/m2, P = 0.02). The same result were observed in the male subgroup, the HI ≥ 4 group and the male subgroup within the HI ≥ 4 group. CONCLUSIONS The BH, BW and BMI were significantly increased after completing surgical correction of PE using the Nuss procedure, particularly in young males and patients with more pronounced deformities.
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Affiliation(s)
- Nay Htut
- Division of Thoracic Surgery, Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - I-Shiang Tzeng
- Department of Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- Department of Statistics, National Taipei University, New Taipei City, Taiwan
| | - Yu-Jiun Fan
- Division of Thoracic Surgery, Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Yeung-Leung Cheng
- Division of Thoracic Surgery, Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.
- School of Medicine, Tzu Chi University, Hualien, Taiwan.
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Song J, Wang Q, Pan Z, Wu C, Li Y, Wang G, Dai J, Xi L, Li H. The Safety and Efficacy of the Modified Single Incision Non-thoracoscopic Nuss Procedure for Children With Pectus Excavatum. Front Pediatr 2022; 10:831617. [PMID: 35211432 PMCID: PMC8861268 DOI: 10.3389/fped.2022.831617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 01/14/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study described and evaluated the safety and efficacy of a modified single incision non-thoracoscopic Nuss procedure in pectus excavatum (PE) children. METHODS PE patients undergoing the non-thoracoscopic Nuss procedure at the Children's Hospital of Chongqing Medical University between January 2017 and December 2020 were retrospectively enrolled. The patients were divided into two groups according to operation procedures: the double incision Nuss (DN) group and the modified single incision Nuss (SN) group. Propensity score matching (PSM) was applied before evaluation of operative and postoperative characteristics to reduce selection bias. RESULTS Of the 502 patients included, 261 were enrolled in the DN group, and 241 in the SN group. The operation time [35.0 (30.0-40.0) vs. 50.0 (40.0-55.0) minutes, P < 0.001] and postoperative inpatient stay [7.0 (6.0-8.0) vs. 7.0 (7.0-8.0) days, P < 0.001] of the patients in the SN group after PSM were significantly shorter than those of the patients in the DN group after PSM. Moreover, median blood loss was significantly less in the SN group after PSM than that in the DN group after PSM [2.0 (1.0-5.0) vs. 5.0 (2.0-5.0) ml, P < 0.001]. There were no significant differences in the incidence of complications between the two groups (P > 0.05). Bar removal was performed in 85 patients in the SN group within 24-42 months after surgery. Additionally, the SN group patients had a significantly lower Haller index (HI) after bar removal [2.36 (2.15-2.55) vs. 3.76 (3.18-4.26), P < 0.001] compared to the initial HI. CONCLUSIONS The modified procedure is safe and effective for children with PE and is worthy of clinical application.
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Affiliation(s)
- Jishuo Song
- Department of Day Surgery Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Quan Wang
- Department of Cardiothoracic Surgery Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Zhengxia Pan
- Department of Cardiothoracic Surgery Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Chun Wu
- Department of Cardiothoracic Surgery Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yonggang Li
- Department of Cardiothoracic Surgery Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Gang Wang
- Department of Cardiothoracic Surgery Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Jiangtao Dai
- Department of Cardiothoracic Surgery Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Linyun Xi
- Department of Cardiothoracic Surgery Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Hongbo Li
- Department of Cardiothoracic Surgery Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
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Huang HK, Huang YJ, Lin KH, Chen YY, Ko KH, Chang H, Lee SC, Huang TW. Severity of Pectus Excavatum is a Risk Factor for Primary Spontaneous Pneumothorax. World J Surg 2021; 44:2035-2041. [PMID: 32040606 DOI: 10.1007/s00268-020-05412-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVE This study aimed to investigate the relationship between bleb formation, primary spontaneous pneumothorax (PSP) and pectus excavatum (PE). METHODS From July 2005 to December 2016, the records of 514 patients with PE who underwent the Nuss procedure were obtained from a prospectively collected database and reviewed. Clinical features, images and treatments were analyzed retrospectively. RESULTS The incidence rate of bleb formation was 26.5% in PE patients. The bleb group had a greater body height (174.4 cm vs. 170.4 cm, p < 0.001), a higher Haller index (HI; 4.2 vs. 3.43, p < 0.001) and a higher risk of developing PSP than the non-bleb group (risk ratio 9.8, p = 0.002). HI values larger than 3.615 had good discriminatory power for predicting bleb formation in patients with PE. With each increase in the HI, PE patients had a 2.2-fold greater odds ratio of bleb formation (odds ratio 2.221, CI 1.481-3.330, p < 0.001). CONCLUSION We discovered that a high percentage of PE patients have bleb formation and a higher risk of PSP, especially those with an HI >3.615. High-resolution computed tomography of the chest may be useful for evaluating both the HI and the presence of blebs in the lungs before performing a corrective surgical procedure.
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Affiliation(s)
- Hsu-Kai Huang
- Division of Thoracic Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu District, Taipei, 11490, Taiwan
| | - Yi-Jhih Huang
- Division of Thoracic Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu District, Taipei, 11490, Taiwan
| | - Kuan-Hsun Lin
- Division of Thoracic Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu District, Taipei, 11490, Taiwan
| | - Ying-Yi Chen
- Division of Thoracic Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu District, Taipei, 11490, Taiwan
| | - Kai-Hsiung Ko
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hung Chang
- Division of Thoracic Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu District, Taipei, 11490, Taiwan
| | - Shih-Chun Lee
- Division of Thoracic Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu District, Taipei, 11490, Taiwan
| | - Tsai-Wang Huang
- Division of Thoracic Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu District, Taipei, 11490, Taiwan.
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Biavati M, Kozlitina J, Alder AC, Foglia R, McColl RW, Peshock RM, Kelly RE, Kim Garcia C. Prevalence of pectus excavatum in an adult population-based cohort estimated from radiographic indices of chest wall shape. PLoS One 2020; 15:e0232575. [PMID: 32379835 PMCID: PMC7205298 DOI: 10.1371/journal.pone.0232575] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 04/17/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Pectus excavatum is the most common chest wall skeletal deformity. Although commonly evaluated in adolescence, its prevalence in adults is unknown. METHODS AND FINDINGS Radiographic indices of chest wall shape were analyzed for participants of the first (n = 2687) and second (n = 1780) phases of the population-based Dallas Heart Study and compared to clinical cases of pectus (n = 297). Thoracic computed tomography imaging studies were examined to calculate the Haller index, a measure of thoracic axial shape, and the Correction index, which quantitates the posterior displacement of the sternum relative to the ribs. At the level of the superior xiphoid, 0.5%, 5% and 0.4% of adult Dallas Heart Study subjects have evidence of pectus excavatum using thresholds of Haller index >3.25, Correction index >10%, or both, respectively. Radiographic measures of pectus are more common in females than males and there is a greater prevalence of pectus in women than men. In the general population, the Haller and Correction indices are associated with height and weight, independent of age, gender, and ethnicity. Repeat imaging of a subset of subjects (n = 992) demonstrated decreases in the mean Haller and Correction indices over seven years, suggesting change to a more circular axial thorax, with less sternal depression, over time. CONCLUSIONS To our knowledge, this is the first study estimating the prevalence of pectus in an unselected adult population. Despite the higher reported prevalence of pectus cases in adolescent boys, this study demonstrates a higher prevalence of radiographic indices of pectus in adult females.
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Affiliation(s)
- Mikaela Biavati
- Eugene McDermott Center for Human Growth and Development, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Julia Kozlitina
- Eugene McDermott Center for Human Growth and Development, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Adam C. Alder
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Robert Foglia
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Roderick W. McColl
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Ronald M. Peshock
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Robert E. Kelly
- Department of Surgery and Pediatrics, Eastern Virginia Medical Center and Children’s Hospital of the King’s Daughters, Norfolk, VA, United States of America
| | - Christine Kim Garcia
- Eugene McDermott Center for Human Growth and Development, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
- * E-mail:
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Jeong SC, Kim JJ, Kim YH, Kim IS, Han JW. Serum lactate dehydrogenase activity and its isoenzyme patterns in patients with pectus excavatum. J Thorac Dis 2019; 11:4349-4356. [PMID: 31737320 DOI: 10.21037/jtd.2019.09.49] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background In previous study, we found elevated serum total lactate dehydrogenase (LDH) before correction of pectus excavatum and a decrease in total LDH after the deformity correction. In the present study, we analyzed total LDH activity and its isoenzyme patterns to investigate the causes of these laboratory findings in patients with pectus excavatum. Methods Between March 2014 to December 2018, 85 patients with pectus excavatum who had undergone the Nuss procedure (NP) and bar removal (BR) were included into this study. We analyzed (I) total LDH and its isoenzyme patterns before the correction, (II) relationships of total LDH and its isoenzymes with age at time of NP, sex, severity of pectus excavatum, and pectus morphology types, and (III) post-corrective changes. Results The mean age of the patients was 13.6 (±6.5) years at the age of NP and the mean interval between NP and BR was 2.2 (±0.42) years. Seventy-one males and 14 females were included. The pectus types included 54 symmetric and 31 asymmetric cases. The mean Haller index before NP and BR were 3.8±1.45 and 2.7±0.4, respectively. The mean of total LDH before NP (pre-correction) and BR (post-correction) were 404.2±80.8 and 369.2±79.3 IU/L, respectively. Before correction, total LDH was significantly higher than normal values, irrespective of age [the young group (<10 years old), P=0.006, and the old group (≥10 years old), P<0.001]. The proportion of LDH5 was significantly higher than that of LDH4 (P<0.001). Total serum LDH was significantly associated with age at time of NP and Haller index (P<0.001 and P=0.030). There was no significant correlation between severity and total LDH. However, the value of only LDH5 among all isoenzymes had a significant positive correlation with severity (P=0.006) and the proportion of only LDH5 in the severe group was significantly higher (P=0.003). After correction, proportions of each isoenzyme were all within the reference range, however, there were significant decreases in values of LDH1-LDH4, except LDH5 (P=0.020, P<0.001, P<0.001, and P=0.029). Conclusions This study shows that pectus excavatum is a muscular disease entity and that laboratory findings are associated with compression of internal organs, which was explained by post-corrective changes in LDH activity and its isoenzyme patterns. This study will provide a deeper and wider comprehension of pectus excavatum.
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Affiliation(s)
- Seong Cheol Jeong
- Department of Thoracic and Cardiovascular Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea Seoul, Gyeonggi-do, Korea
| | - Jae Jun Kim
- Department of Thoracic and Cardiovascular Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea Seoul, Gyeonggi-do, Korea
| | - Yong Hwan Kim
- Department of Thoracic and Cardiovascular Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea Seoul, Gyeonggi-do, Korea
| | - In Sub Kim
- Department of Thoracic and Cardiovascular Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea Seoul, Gyeonggi-do, Korea
| | - Jung Wook Han
- Department of Thoracic and Cardiovascular Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea Seoul, Gyeonggi-do, Korea
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Cho DG, Kim JJ, Park JK, Moon SW. Recurrence of pectus excavatum following the Nuss procedure. J Thorac Dis 2018; 10:6201-6210. [PMID: 30622792 DOI: 10.21037/jtd.2018.10.31] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The recurrence of pectus excavatum (PE), in other words, chest wall depression after the completion of repair, is one of the most important issues in PE. However, little about the recurrence of PE is known. The present study aimed (I) to evaluate the characteristics of chest wall depression during treatment and (II) to present the definition of recurrence of PE, investigate the risk factors for recurrence, and predict the recurrence at one year after bar removal (BR). Methods Consecutive 99 patients who had undergone BR for PE in a single hospital from March 2012 to June 2017 were included in the present study. Severity of PE is presented as a radiographical Haller index (RHI) in the present study. RHI is calculated by the ratio of the transverse diameter to the anteroposterior (AP) diameter at the point of the deepest chest wall depression. Patients with a ≥3.5 RHI value, which simultaneously increased to more than the value of RHI before BR, were considered as demonstrating recurrence in the present study. Follow-up data after BR were collected at subsequent time points (i.e., immediate before and after, one month, sixth months, and one year after BR). All postoperative chest wall changes were analyzed to find out the difference according to the age at the time of the Nuss procedure (NP) [<10 years old (early group; EG) vs. ≥10 years old (late group, LG)]. Results The mean age of patients was 8.91 (±5.23) years at the age of the NP and the mean duration of bar placement was 28.4 (±5.04) months. Seventy-eight males and 21 females were included. The pectus type was 79 symmetric and 20 asymmetric cases. The mean observation period after BR was 16.47 (±3.74) months. There was a significant correlation between the Haller index using chest CT and simple radiography data (P<0.001). Irrespective of the age groups, there were a significant decrease in RHI values after the NP (both P<0.001). In addition, there were no differences in RHI values between the EG and the LG cohort before the NP and immediately after the NP (P=0.775, P=0.356, respectively). RHI values was significantly decreased in the EG (P=0.040) and increased without a significance in the LG (P=0.330) during bar placement. The chest wall depression progressed for the first six months after BR. However, the chest wall depression did not progress one year after BR. Recurrence occurred in nine cases at one year after BR (four cases in the EG and five cases in LG). The recurrence rate was higher in the LG than in the EG without a significance (P=0.479). Multivariate analysis of the recurrence revealed that only RHI after the NP was identified as an independent risk factor of the recurrence. ROC study also showed that RHI value after the NP had a significant predictable cutoff value for the recurrence [cutoff value of RHI: 2.91, sensitivity: 88.9%, specificity: 90.0%, P<0.001, area: 0.899, 95% confidence interval (CI): 0.806-0.993]. Conclusions The present study shows the characteristics of chest wall depression and the risk factor of the recurrence of PE after BR. The effect of the NP is different according to the patient age at the time of the procedure. Early correction of PE can provide better corrective results because of the existence of a more pliable chest wall, which can be easily and sufficiently elevated by the NP. Sufficient elevation of the depressed chest wall should be ensured during the NP to prevent the recurrence of PE.
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Affiliation(s)
- Deog Gon Cho
- Department of Thoracic and Cardiovascular Surgery, St. Vincent's Hospital, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Jae Jun Kim
- Department of Thoracic and Cardiovascular Surgery, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Jae Kil Park
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Seok Whan Moon
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Seoul, Korea
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A Novel Objective Approach to the External Measurement of Pectus Excavatum Severity by Means of an Optical Device. Ann Thorac Surg 2018; 106:221-227. [DOI: 10.1016/j.athoracsur.2018.02.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 02/07/2018] [Accepted: 02/12/2018] [Indexed: 11/24/2022]
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Differences in myocardial strain between pectus excavatum patients and healthy subjects assessed by cardiac MRI: a pilot study. Eur Radiol 2017; 28:1276-1284. [DOI: 10.1007/s00330-017-5042-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 08/14/2017] [Accepted: 08/18/2017] [Indexed: 12/12/2022]
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Complications after pectus excavatum repair using pectus bars in adolescents and adults: risk comparisons between age and technique groups†. Interact Cardiovasc Thorac Surg 2017; 25:606-612. [DOI: 10.1093/icvts/ivx162] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 04/20/2017] [Indexed: 11/14/2022] Open
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