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Biomedical subjects

T M Agnew

Publications and source records attributed to T M Agnew.

30 records · Page 2Linked to original sources
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.

Explore the source record for details and available documents.

Anti-Bacterial Agents↗
PubMed1970

Premature valve closure in patients with a mitral Starr-Edwards prosthesis and aortic incompetence.

A mitral Starr-Edwards ball valve has, in three patients with concomitant aortic incompetence, permitted recognition of intermittent premature valve closure by auscultation and this has been documented by phonocardiograms. In two instances the observations were confirmed during cardiac catheterization. The features of premature Starr valve closure are described and the mechanism is discussed.

Aortic Valve↗
PubMedDate not supplied

Survival after heart transplantation without regular immunosuppression.

The case of a young woman who discontinued regular immunosuppression 4 years after heart transplantation is described. A year later she became unwell and explained her actions. A cardiac biopsy showed changes of focal moderate rejection, which responded to treatment, and she is presently in good health.

Adolescent↗