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Biomedical subjects

T M Agnew

Publications and source records attributed to T M Agnew.

At least 19 recordsLinked to original sources
PubMed1992

The role of dipyridamole in addition to low dose aspirin in the prevention of occlusion of coronary artery bypass grafts.

One hundred and one subjects were randomised to receive either aspirin 100 mg or aspirin 100 mg + dipyridamole 300 mg daily before undergoing coronary bypass surgery. The drugs were commenced at least 36 hours before operation and patients were followed for one year. There were three perioperative deaths and 37 withdrawals, of which 14 were drug related (aspirin four, aspirin + dipyridamole ten). Cineangiocardiograms at nine weeks and one year showed vein graft patency rates of 93% and 87% for subjects treated with aspirin alone; and 90% and 89% in those who received aspirin+dipyridamole. During the follow-up period 14% of 232 coronary lesions in the aspirin treated group advanced by more than two grades compared with 15% of 315 lesions in the aspirin+dipyridamole group. The study did not establish superiority of one regimen over another in terms of graft patency or progress of lesions in native vessels. However, low dose aspirin was better tolerated than combination therapy.

Aged↗
PubMed1989

Cardiac transplantation in New Zealand: an initial report.

During the first 18 months of its establishment, the cardiac transplant unit at Green Lane Hospital has undertaken 10 transplant operations. Fifty potential recipients have been referred and 15 were accepted for transplantation. Of the ten who have had surgery, 2 are making good progress at school, 1 is active at home and 5 have returned to work. Two patients have died.

Adult↗
PubMed1984

The results of surgical treatment of left ventricular aneurysms. An assessment of the risk factors affecting early and late mortality.

The surgical results of left ventricular aneurysmectomy have been examined in 145 patients during a 13 year period. In 113 patients (78%) coronary artery bypass grafting (CABG) was also undertaken. There were 22 hospital deaths (15%) and 44 late deaths (30%). Stepwise, multiple regression analyses were used to examine many variables and to establish risk factors for hospital and late mortality. The chances of hospital death were increased by worsening New York Heart Association (NYHA) class, severe congestive heart failure (CHF), and extensive coronary disease. The risk of late mortality was increased by a significant right coronary artery stenosis and by poor contractility of the posterobasal segment. The probability of late death was reduced by a history of preoperative angina and an increasing number of grafts.

Adult↗
PubMed1983

Sudden cardiac death: results of resuscitation begun outside hospital.

A retrospective review was undertaken to determine the influence of the St John Ambulance life support units on the the incidence of sudden cardiac death during a 12 month period in Auckland. In 65 instances subjects who collapsed with either ventricular fibrillation or cardiac arrest were resuscitated and transported alive to a hospital accident and emergency department in the Auckland area. Twenty patients died within 24 hours of admission and a further 14 died in hospital. There were seven late deaths and 24 survivors (37%). Ten patients are asymptomatic and the remainder are troubled by angina or breathlessness. Only three of the surviving patients have suffered severe cerebral damage as a result of their collapse.

Adult↗
PubMed1981

Infective endocarditis: a lethal disease.

One-hundred-and-eighty-nine episodes of infective Endocarditis were seen in 177 patients in the Green Lane Cardiology Unit over a 18-year period. Hospital survival was 79% and 13-year actuarial survival was 47%. A number of factors including the underlying cardiac lesion, infecting organism, clinical features and surgical intervention were related to outcome. No patient with extreme heart failure survived without operation. Hospital survival in patients with severe heart failure was 69% (9/13 patients) where surgery was carried out before completion of antibiotic treatment, and 40% (6/15 patients) where the antibiotic course was completed. Survival was 53% in patients who still had a fever after one week of antibiotic treatment and 96% if the temperature was normal. In 61% of patients with a fever at one week, extended infected pannus was present compared with 6--10% where the temperature was normal. In patients undergoing operation before completion of antibiotics, the surgical mortality was higher but neither the incidence of recurrence of endocarditis nor the need for re-operation was increased. We believe that better results will be achieved with a policy of surgical intervention when signs of infection and heart failure have not settled within one week of treatment.

Actuarial Analysis↗
PubMed1981

Coronary surgery after recurrent myocardial infarction: progress of a trial comparing surgical with nonsurgical management for asymptomatic patients with advanced coronary disease.

A randomized trial of surgical vs nonsurgical management was carried out in men 60 years of age or younger who had recovered from a recurrent myocardial infarction. Of 205 patients considered, 100 had few or no symptoms and had coronary vessels favorable for bypass grafting; these patients fulfilled the trial conditions and were randomized (50 surgical and 50 nonsurgical). In 41 patients (elective nonsurgical group), randomization was not considered justifiable because of relatively unfavorable coronary anatomy or severe left ventricular dysfunction. Nineteen patients had elective surgery because of disabling angina despite full medical treatment or because of significant left main coronary stenosis. In 45 patients, coronary angiography was not undertaken because of medical contraindications or reluctance of the patient to enter the study. Actuarial survival curves (mean follow-up 4.5 years) show an annual mortality rate of 3-4% per year for all investigated patients, and no advantage for the randomized surgical over the randomized nonsurgical group. The results suggest that in the absence of disabling angina or left main coronary artery stenosis, coronary artery surgery need not be advised for survivors of recurrent infarctions who have severe coronary artery disease. Moreover, the prognosis for the group of patients not treated surgically appears to be better than has been previously described.

Adult↗
PubMed1977

Surgical resection in idiopathic hypertrophic subaortic stenosis with a combined approach through aorta and left ventricle.

The operative technique and the immediate and long-term results are described in 49 patients who have undergone myectomy for IHSS. There was a 4 percent early and 12 percent late mortality rate and surviving patients have been followed for up to 13 years. The operation has resulted in a striking symptomatic improvement in most patients in association with relief of outflow obstruction and mitral regurgitation. Chronic atrial fibrillation was poorly tolerated but has not occurred as a late complication in any of the patients operated upon.

Adolescent↗
PubMed1977

Isolated mitral replacement with stent-mounted antibiotic-treated aortic allograft valves.

The results of valve replacement with a stent-mounted antibiotic-treated aortic allograft valve are reported in 129 patients with isolated mitral valve disease. Of these patients, 70 per cent were in N.Y.H.A. Class IV. The hospital mortality rate was 3.9 percent. The cumulative complication-free rate at 5 years was only 37 percent as 21 percent died late, a further 15 percent were alive following reoperation, 4 percent had an embolic episode, 4 percent were alive with important incompetence, and 20 percent had unimportant incompetence. Proved valve failure was due mainly to detachment of the aortic wall remnant of the valve from the pillar of the rigid metal stent (16 percent incidence at 5 years) and methods for preventing this complication are discussed. Because of these complications the use of this device in the mitral position has been discontinued.

Adolescent↗
PubMed1976

Cardiac rupture with false aneurysm after myocardial infarction.

A case of cardiac rupture is reported after myocardial infarction. Leaking blood was contained within the pericardium and a false aneurysm developed. Ten months later this was successfully repaired. The neck of the aneurysm was transected, the defect in the left ventricle closed and saphenous vein bypass grafts were applied to the anterior descending and right coronary arteries. The literature on this subject is briefly reviewed.

Heart Aneurysm↗
PubMed1976

The natural history of rheumatic aortic regurgitation and the indications for surgery.

A detailed review was made of 180 patients with severe aortic regurgitation of rheumatic origin. Of these patients, 110 underwent aortic valve replacement. Thirty-nine clinical and haemodynamic factors were studied in an attempt to define those associated with (1) death before surgery, (2) a higher incidence of complications and hospital mortality after surgery, and (3) an unsatisfactory longer-term result of surgery. Only heart failure, radiographic heart size, left ventricular hypertrophy, and ventricular premature beats were associated with death before surgery. No factor predisposed to surgical complications and only preoperative factors associated with an unfavourable result after surgery were advanced heart failure, cardiomyopathy, extreme cardiomegaly, and ventricular premature beats. It is concluded that the indications for operation are: a cardiothoracic ratio of greater than 0-60, or a history of heart failure combined with electrocardiographic evidence of extreme left ventricular hypertrophy. Operation may be safely postponed if these indications are not met, though the presence of ventricular extrasystoles or evidence of independent myocardial disease are further factors which should influence the decision.

Adolescent↗
PubMed1972

Homograft valves.

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Anti-Bacterial Agents↗