고혈압 환자에서 내피의존성 혈관반응에 대한 칼슘길항제와 비타민 C 의 효과에 대한 요구

온영근(Young Yeun On),최진호(Jin Ho Choi),채인호(In Ho Chae),김철호(Cheol Ho Kim),손대원(Dae Won Sohn),오병희(Byung Hee Oh),이명묵(Myoung Mook Lee),박영배(Young Bae Park),최윤식(Yun Shik Choi) 대한내과학회 2001 대한내과학회지 Vol.61 No.5

N/A Background: The effect s of antihypertensive agents on endothelial function have not been fully evaluated in human hypertension and data on the forearm circulation of humans are controversial. The aim of this study was 1) to evaluate the endothelial function in hypertensive patients 2) to investigate whether vitamin C administration has any benefit on the endothelial function and 3) to determine whether treatment with calcium ant agonist improves endothelial dysfunction in hypertensive patients. Methods: The endothelial function was estimated using venous occlusion plethysmography (VOP) in 8 hyper tensive patients and 8 healthy volunteer s. The patients in the hypertension group were treated with amlodipine, then examined again. The change of forearm blood flow (FBF) was measured wit hacetylcholine infusion through brachial artery and also with intra-ar terial vitamin C. Results: Forearm blood flow response to acetylcholine was significantly enhanced with intra- arterial infusion of vitamin C in hypertensive group before antihypertensive treatment. Co- infusion of L- NMMA, an inhibit or of nitric oxide synthase, blunted forearm blood flow response toacetylcholine. After treatment with amlodipine for 2 months in hypertensive group, endothelium-dependent vasorelaxation to acetylcholine was significantly improved comparedt opretreatment, and vitamin C did not affect the improved endothelial function by amlodipine treatment. Conclusion: Vitamin C (acutely) and amlodipine (chronically) improved endothelial function inhypertensive patients. These results suggest that increased oxidative stress, at least in part , maybe involved in the decreased endothelial function in hypertension.(Korean J Med 61:518- 526, 2001)

출생 후 제대혈관 폐쇄에서의 세포고사

황경국(Kyung Kuk Hwang),김효수(Hyo Soo Kim),서정욱(Jung Uk Seo),채인호(In Ho Chae),손대원(Dae Won Sohn),오병희(Byung Hee Oh),이명묵(Myoung Mook Lee),박영배(Young Bae Park),최윤식(Yun Shik Choi),서정돈(Jung Don Seo),이영우(Young Woo L 대한내과학회 1998 대한내과학회지 Vol.55 No.6

N/A Background: The mechanism of the closure of umbilical vessels is known to be multifactorial. In order to verify that apoptosis is one of the possible closure mechanisms, we studied to identify apoptosis in umbilical vessels and evaluate its mechanism by studying apoptosis-related gene and the relationship between the pattern of apoptosis and gestational age (GA). Methods: Twelve umbilical cords of GA of 37-42 weeks were obtained immediatly (less than 10 min. for minimal ongoing external influences) after birth. The presence of apoptotic cells was demonstrated by electron microscopy (EM) and terminal deoxynucleotidyl transferasemediated dUTP nick end labeling (TUNEL). Immnohistochemical staining and Western blotting were used for the analysis of the proteins of apoptosis-related gene. Results: Apoptosis of the smooth muscle cells of media and intima of umbilical vessels was identified at EM, regardless of GA from 37 to 42 weeks. The proportion of TUNEL(+) cells was 80% in intima, 40% in media, 80% in connective tissue of umbilical cord. The expressions of bax-a, bcl-Xs/L were strong in intima, in media and connective tissue, but those of bcl-2 were detected in only in connective tissue, regardless of GA in immunohistochemistry. The ratios of expressions of bax- a to bc1-2, bcl-Xs to bcl-XL, did not change with increasing GA from 37 to 42 weeks in Western blot- ting. Conclusion: Apoptosis was identified in umbilical vessels. The closure of umbilical vessels can be explained by apoptosis where the ratios of bax-a/bcl-2, bcl-Xs/ bcl-XL play an important role. The fact that there were no differences in the extent of apoptosis and the expressions of bax-a/bcl-2, bcl-Xs/bcl-XL according to GA, suggests that apoptosis of umbilical vessels is more dependent on the external stimuli during delivery than GA.

심폐바이패스없이 심박동상태에서 시행한 관상동맥우회술후 중기 개통율

이철,장우익,임청,김기봉,채인호,오병희,이명묵,박영배,Lee, Cheul,Chang, Woo-Ik,Lim, Cheong,Kim, Ki-Bong,Chae, In-Ho,Oh, Byung-Hee,Lee, Myoung-Mook,Park, Young-Bae 대한흉부심장혈관외과학회 2001 Journal of Chest Surgery (J Chest Surg) Vol.34 No.8

배경: 심폐바이패스없이 심박동상태에서 시행하는 관상동맥우회술 후의 각종 도관들의 1년째 개통율을 심패바이패스하의 심정지상태에서 시행하는 통상적 관상동맥우회술 및 심폐바이패스하의 심박동상태에서 시행한 관상동맥우회술 후의 1년재 개통율과 각각 비교하고 그 차이를 알아보고자 하였다. 대상 및 방법: 심폐바이패스없이 심박동상태에서 시행한 관상동맥우회술(I군; n=122)의 결과를 심폐바이패스하의 심정지상태에서 시행하는 통상적 관상동맥우회술(II군; n=65) 및 심폐바이패스하의 심박동상태에서 시행하는 관상동맥우회술(III군; n=19)의 결과와 비교, 분석하였다. I 군에서는 수술 직후와 수술후 1년째에 관상동맥조영술이 시행되었고, II군 및 III군에서는 수술후 1년째에서 시행되었다. 도관의 개통정도는 A(excellent), B(fair), 혹은 O(occluded)의 3등급으로 평가하였다. 결과: I, II, III군에서의 평균 원위 문합수는 각각 3.1$\pm$1.1, 3.7$\pm$0.9, 3.6$\pm$0.9개 이었다. I 군에서는 92%(112/122)의 환자들에서 퇴원 전 관상동맥조영술이 시행되었는데 개통율 (A+B)은 동맥 도관이 96.4%(162/168), 복재정맥이 85.6%(160/187) 이었다. 74%(90/122)의 환자들에서 술후 1년째 관상동맥조영술이 시행되었으며, 개통율은 동맥 도관이 97.89%(132/135), 복재정맥이 67.9%(106/156) 이었다. II군에서는 65%(42/65)의 환자들에서 술후 1년째 관상동맥조영술이 시행되었다. 개통율은 동맥 도관이 93.5%(43/46), 복재정맥이 88.3%(98/111) 이었다. III군에서는 89%(17/19)DML 환자들에서 술후 1년째 관상동맥조영술이 시행되었다. TRO통율은 동맥 도관이 100%(19/19), 복재정맥이 86.8%(33/38) 이었다. 결론: 세 군간에 동맥 도관들의 1년째 개통율은 유의한 차이를 보이지 않았다. 심폐바이패스 없이 심박동상태에서 시행하는 관상동맥우회술후 복재정맥의 개통율은 수술 직후에도 동맥 도관에 비하여 유의하게 낮았으며(p<0.001), 술후 1년째 복재정맥 개통율 또한 II군(p<0.001) 및 III(p<0.01)의 수술후 1년째 복재정맥 개통율에 비하여 유의하게 낮았다. 이러한 결과는 복재정맥을 이용하여 심폐바이패스없이 시행하는 관상동맥우회술의 경우, 수술전후 항응고 요법에 특별한 주의가 필요할 것이라는 사실을 시사한다. The aim of this study was to compare one-year graft patency after coronary artery bypass grafting without cardiopulmonary bypass(OPCAB) with that of conventional CABG and that of on-pump beating CABG, and to demonstrate any differences in patency of various conduits among the three groups. Material and Method: We analyzed the results of OPCAB cases(group I; n=122) compared with those of conventional CABG cases(group II; n=65) and those of on-pump beating CABG cases(group III; n=19). In group I, coronary angiography(CAG) was performed immediately postoperatively and 1 year after surgery. In group II and III, CAG was performed 1 year after surgery. Graft patency was graded as grade A(excellent), grade B(fair), or grade O(occluded). Result: The average number of distal anastomoses in groups I, II, and II were 3.1$\pm$1.1, 3.7$\pm$0.9, and 3.6$\pm$0.9, respectively. In group I, postoperative CAG was performed in 92%(112/122) of patients before discharge. The patency rate(grade A+B) was 96.4$(162/168) for arterial grafts, and 85.6%(160/187) for saphenous vein grafts(SVG). One-year follow-up CAG was performed in 74%(90/122) of patients. The patency rate was 97.8%(132/135) for arterial grafts, and 67.9%(106/156) for SVG. In group II, one-year follow-up CAG was performed in 65%(42/65) of patients. The patency rate(grade A+B) was 93.5%(43/46) for arterial grafts, and 86.8%(33/38) for SVG. Conclusion: Our results demonstrated that the patency rate of SVG after OPCAB was significantly lower than that of arterial grafts in the early postoperative CAG(p<0.001), and was also significantly lower than those of SVG of group II(p<0.001) and group III(p<0.01) in the postoperative one-year CAG, although there was no significant difference is one-year patency of arterial grafts among the three groups. Our data suggest that a specific perioperative anticoagulant therapy may be advisable in patients undergoing OPCAB with SVG.

산화질소-합성효소 유전자의 다형성이 급성 관동맥 증후군과 이형 협심증 환자에 미치는 영향의 차이

최수연(Soo Yeon Choi),유경훈(Kyung Hoon Yoo),박진식(Jin Sik Park),채인호(In Ho Chae),김효수(Hyo Soo Kim),손대원(Dae Won Son),오병희(Byung Hee Oh),이명묵(Myoung Mook Lee),박영배(Young Bae Park),최윤식(Yun Shick Choi),이영우(Young Woo 대한내과학회 2000 대한내과학회지 Vol.58 No.1

N/A Background : Nitric oxide, also known as endothelial derived relaxing factor(EDRF), regulates the vascular tone and inhibits the proliferation of vascular smooth muscle cells and platelet adhesions and endothelium-leukocyte interactions. Thus, nitric oxide may be involved in the pathogenesis of atherosclerosis and vasospasm. We analyzed the genotype distributions of two eNOS gene polymorphisms in normal healthy Koreans and compared it with those in the patients with acute coronary syndrome and variant angina. Methods : We analyzed the two eNOS polymorphisms (eNOS A/B polymorphism is the variable numbers of tandem repeat in intron 4 and eNOS T/G polymorphism is a mis-sense mutation in exon 7) using PCR and clinical characteristics of the risk factors for coronary artery disease in 142 normal healthy Koreans and 164 patients with acute coronary syndrome and 104 patients with variant angina. Results : The genotype distribution of A/B polymorphism of eNOS gene, A/A, A/B, B/B was 4.9%, 21.1%, 74% in control group and 2.4%, 12.8%, 84.8% in the patients with acute coronary syndrome(p=0.02) and 2.9%, 16.3%, 80.8% in the patients with variant angina(p=NS), respectively. The genotype distribution of T/G polymorphism of eNOS gene, T/T, T/G, G/G was 1.4%, 15.5%, 83.1% in control group and 0.6%, 21.3%, 78.1% in the patients with acute coronary syndrome(p=NS) and 0%, 18.3%,81.7% in the patients with variant angina(p=NS), respectively. The odds ratio for acute coronary syndrome of non B/B(A/A & A/B) to B/B was 0.489 (95% CI : 0.257∼0.928). We found that age, sex (male), diabetes mellitus, hyperlipidemia, smoking, B/B genotype were independent risk factors for acute coronary syndrome. But, in variant angina, smoking was the only significant independent risk factor(odds ratio=5.934, 95% CI 2.843-12.388, p<0.05). Conclusion : The B/B genotype frequency of eNOS gene was significantly higher in patients with acute coronary syndrome than in normal controls. But neither A/B nor T/G polymorphism of eNOS gene was associated with variant angina. These results suggest that eNOS gene may play some roles in the pathogenesis of ACS rather than vasospasm.(Korean J Med 58:19-27, 2000)

고콜레스테롤혈증 환자에서 내피의존성 혈관반응에 대한 스타틴과 비타민 C의 효과에 대한 연구

온영근(Young Keun On),성지동(Ji Dong Sung),채인호(In Ho Chae),김철호(Cheol Ho Kim),손대원(Dae Won Sohn),오병희(Byung Hee Oh),이명묵(Myoung Mook Lee),박영배(Young Bae Park),최윤식(Yun Shik Choi) 대한내과학회 2001 대한내과학회지 Vol.60 No.3

N/A Background : Hypercholesterolemia is firmly established as a risk factor for the development of atherosclerosis. However the exact mechanism of hypercholesterolemia-related damage to the arterial wall and its relation to the atherosclerotic process are not well known. The endothelium plays an important role for the regulation of vascular tone and the endothelial function is impaired in the presence of risk factors early in the process of atherosclerosis. Assessment of endothelial function appears to be a valuable tool for the diagnosing and therapeutic monitoring of coronary artery disease. Lipid lowering agents and anti-oxidants are known to improve endothelial dysfunction in hypercholesterolemic patients, respectively. The purpose of this study is to investigate whether vitamin C has additional benefit on endothelial function of statin-treated hypercholesterolemic patients. Methods : The endothelial function was estimated using venous occlusion plethysmography (VOP) in 9 hypercholesterolemic patients and 11 healthy volunteers. The strain guage was connected to plethysmograph to record the forearm volume change. A rapid cuff inflator was used to inflate the arm cuff to 40 mmHg instantaneuosly thus occluding venous return from the forearm. The measurement of forearm volume change was repeated for 7 times each stage. The patients in the hypercholesterolemic (HC) group were treated with the statin, then examined again. The change of the forearm blood flow (FBF) was measured with the acetylcholine infusion through brachial artery and also with intra-arterial vitamin C. Results : Endothelium-dependent vasodilatation was significantly impaired in the HC group compared to the control group (15.9±0.9 mL/min/100mL forearm tissue, vs 8.9±0.6 mL/min/100mL forearm tissue, mean±standard error of mean, p<0.05). The FBF increased significantly after statin therapy (8.9±0.6 vs 25.2±1.4 mL/min/100mg forearm tissue, p<0.05). Vitamin C infusion in these patients results in additional improvement in FBF (25.2±1.4 vs 31.9±2.1, p<0.05). Conclusion : Endothelium-dependent vasodilatation was significantly impaired in the HC group compared to the control group. The FBF increased significantly after statin therapy. Vitamin C seems to have additional benefit on the endothelial function of statin-treated hypercholesterolemic patients.(Korean J Med 60:206-214, 2001)

성인에서의 심장이식 - 17 예 경험에 대한 보고 -

오병희(Byung Hee Oh),강현재(Hyun Jae Kang),정우영(Woo Young Chung),채인호(In Ho Chae),김효수(Hyo Soo Kim),손대원(Dae Won Sohn),이명묵(Myoung Mook Lee),박영배(Young Bae Park),최윤식(Yun Sik Choi),서정돈(Jung Don Seo),이영우(Young Woo 대한내과학회 1998 대한내과학회지 Vol.55 No.3

N/A Background: Cardiac transplantation has been established as a treatment of choice for patients with endstage heart failure. However, the experiences of cardiac transplantation are still limited in Korea. Methods Seventeen adult cardiac transplantations (13 males and 4 females) were performed in Seoul National University Hospital since March 1994. Clinical outcome & course, acute rejection, and complications among transplanted patients were reviewed. Results: Underlying cardiac conditions leading to cardiac transplantation were dilated cardiomyopathy in 9, valvular heart disease with severe LV dysfunction after prosthetic valve replacement in 3, restrictive cardiomyopathy in 2, ischemic cardiomyopathy in 1, intractable ventricular tachyarrhythmia in 1 and hypertrophic cardiomyopathy with severe LV dysfunction in 1 patient. Ages of recipients were between 22 and 54 (median-38). Mean follow up duration was 27 months (1-45 months). The frequencies of rejection decreased with time and were similar to those of previous reports 1.23 episodes of rejections per patients during first 3months after transplantation, 0.25 during second 3months, 0.17 and 0.08 during third and fourth 3 months. Infectious complications developed in 21.4% of patients during the first year after transplantation and infectious agents were Cytomegalovirus (CMV), gram negative bacteria, and Candida. One-year survival rate of recipients was 81.9%. Systemic CMV infection in 1, aortic rupture in 1, and sudden death in 1 patient were the causes of mortality, all of which developed during early post-transplantation period. Conclusion: Cardiac transplantation seems to be a reasonable therapeutic regimen for patient with end stage heart failure even in this country with limited experience; however, close attention and management against acute rejection and infectious complications, especially during the early post-transplantation period, are critical for long term survival.

박작성 심실상성빈맥의 감별진단에 있어서 빈맥시 P 파의 유용성에 대한 연구

송종민(Jong Min Song),최윤식(Yun Shik Choi),채인호(In Ho Chae),김효수(Hyo Soo Kim),손대원(Dae Won Sohn),오병희(Byung Hee Oh),이명묵(Myoung Mook Lee),박영배(Young Bae Park),이영우(Young Woo Lee) 대한내과학회 2000 대한내과학회지 Vol.59 No.3

Background : Retrograde P wave can be found not only in atrioventricular reentrant tachycardia (AVRT) but also in atrioventricular nodal reentrant tachycardia (AVNRT), especially of posterior-type. This study evaluated the usefulness of retrograde P wave for differentiating AVNRT from concealed AVRT and for localization of accessory pathway(AP).Methods : Twelve lead ECGs were analyzed in patients with AVNRT (n=41) and concealed AVRT (n=53) who have taken successful ablation. Presence of pseudo r' in V1, pseudo S in II, III, aVF, and configuration and polarity of presumed retrograde P waves were evaluated. RP was obtained by subtracting RP interval in III from that in V1.Results : In anterior-type AVNRTs (n=38), there were no retrograde P wave in 53% and the pseudo r' and/or S in 47%. Retrograde P waves in V1 were positive in 67% (2/3 cases) of posterior-type AVNRTs and 97.4% (37/38 cases) of AVRTs with left free wall AP, but negative in 83.3% (5/6 cases) of AVRTs with right free wall AP. Retrograde P waves in II, III, aVF were negative in all of posterior-type AVNRTs, all with left and right posteroseptal AP, right posterior AP, and 90% (9/10 cases) with left posterior AP. All with left anterior and right anteroseptal AP showed positive P wave in III. RP of posterior-type AVNRT was significantly larger than those with left posteroseptal or left posterior AP (p<0.01). Sensitivity of newly developed stepwise algorithm was 50-100%.Conclusion : Retrograde P wave during tachycardia on standard ECG is very useful for differentiation of AVNRT from concealed AVRT and also for localization of APs. (Korean J Med 59:268-276, 2000)

가족성 고콜레스테롤 혈증 한국인 환자에서의 저비중 지단백 수용체 유전자의 돌연변이 분석

김효수(Hyo Soo Kim),채인호(In Ho Chae),박영배(Young Bae Park),최성준(Sung Choon Choe),한기훈(Ki Hoon Han),채재진(Jae Jin Chae),김성한(Sung Han Kim) 대한내과학회 1999 대한내과학회지 Vol.57 No.5

N/A Familial hypercholesterolemia (FH) is a common autosomal dominant disorder caused by a defect in the low-density-lipoprotein (LDL) receptor, disrupting the normal control of cholesterol metabolism. We have collected 86 FH families for over 5 years who met following Dx criteria 1) hypercholesterolemia over 280 mg/dl 2) Achilles tendon xanthoma thicker than 9 mm, and 3) familial tendency, and characterized the pattern of mutations in Korea FH patients. Method : Mutation was screened with linkage analysis into two ways; large structural rearrangements were screened by genomic Southern blotting or long-PCR technique, and small structural rearrangements were screened by PCR of each exon followed by SSCP analysis. The exact mutation sites were confirmed by sequencing. Result : 1) Large mutation : Three different large deletions(FH110, FH29, FH32) were found in 7(11.5%) among 61 families screened. FH110 was a deletion of 5.7kb from intron 8 to 12, which was found in 5 unrelated families. FH29 was a deletion of 3.8kb from intron 6 to 8, and FH32 was a deletion of 2kb from intron 6 to 7. These three deletions have not been reported previously. The mechanism of deletion was unequal crossover from mispairing Alu-sequences. 2) Small or point mutations : Nineteen different small mutations were found in 19(31.4%) among 86 families screened . These mutations comprised 9 missense, 3 nonsense, 2 splicing mutations, 3 small deletions, and 2 small insertions. One missense mutation (Pro664Leu) was found in 6 unrelated families. Among these mutations, 12 have not been reported previously.Conclusions : LDL receptor gene mutations are heterogeneous in Korean FH patients. We could not observe founder mutation but detect common mutations.(Korean. J. Med 57:881-895, 1999)

고혈압 환자에 대한 이베사탄의 혈압강하효과 및 안전성을 평가하기 위한 양측 눈가림, 무작위 배정, 에날라프릴과의 비열등성 4상 임상시험

김광일,배장환,강현재,서선예,김상현,오세일,채인호,조주희,김명아,김효수,손대원,오병희,박영배,최윤식,박병주,이명묵,Kim, Kwang-Il,Bae, Jang-Whan,Kang, Hyun-Jae,Suh, Sun-Ye,Kim, Sang-Hyun,Oh, Se-Il,Chae, In-Ho,Zo, Joo-Hee,Kim, Myoung-A,Kim, Hyo-Soo,Sohn 대한임상약리학회 2003 Translational and Clinical Pharmacology Vol.11 No.2

Background: Irbersartan, an orally active antihypertensive agent, effectively reduces blood pressure by blocking angiotensin II receptors without any significant adverse effects. The purpose of this study is to compare the antihypertensive efficacy, safety and tolerability of irbesartan and enalapril in hypertensive patients. Methods: In this two centers, double-blind, randomized, non-inferiority study, the efficacy, safety and tolerability of once-daily irbesartan(150mg) versus once-daily enalapril(10mg) were evaluated over 8 weeks in 67 patients who had diastolic pressure between 95mmHg and 114mmHg on two measurements. If trough sitting diastolic blood pressure was equal to or greater than 90mmHg after a 4-week treatment period, the dosage for both study drugs was doubled until the end of the study. Baseline pressures, antihypertensive effect, side effects, laboratory findings were compared before and after treatment. Results: Data from 57 of 67 patients were eligible for intention to treat analysis. After the 8 weeks treatment with dose titration, mean reductions in peak sitting diastolic blood pressure were 11.9mmHg(95% confidence interval 7.61 -16.13) with irbesartan and 10.9mmHg$(95%\;confidence\;interval\;7.05{\sim}14.70)$ with enalapril. There was no significant difference between the two treatments in the percentage of patients achieving an effective blood pressure reduction or in the degree of change in mean systolic and/or diastolic blood pressure. Safety profiles were also similar between treatments. Conclusions: The antihypertensive efficacy of once-daily administration of irbesartan is non-inferior to that of enalapril in hypertensive patients. Both irbesartan and enalapril are well tolerated with similar safety profiles.

심장 점액종의 임상적 고찰

황의석(Eui Seock Hwang),김용석(Yong Seok Kim),최진오(Jin Oh Choi),채인호(In Ho Chae),손대원(Dae Won Sohn),김철호(Cheol Ho Kim),오병희(Byung Heui Oh),이명묵(Myoung Mook Lee),박영배(Young Bae Park),최윤식(Yun Shik Choi),이영우(Young Wo 대한내과학회 2002 대한내과학회지 Vol.62 No.1

N/A Background: Cardiac myxoma is uncommon, even though accounts for 50% of primary cardiac tumor, histologically benign disease but may be lethal because of its strategic position. It has diverse clinical manifestations mimicking various diseases, which can be described under the three headings: constitutional, obstructive and embolic and the diagnosis can be easily missed unless clinician has high index of suspicion. A correct diagnosis is made before operation with the development of echocardiography. We reviewed our clinical experience in diagnosis and management of 21 cases of myxomas from 1985 to 2000. Methods: There were 4 males (19%) and 17 females (81%). Their ages ranged from 17 to 66 years (mean 42.2 years). All the patient`s medical records on their clinical features, laboratory findings, chest X-rays, electrocardiograms, echocardiographic findings, operative findings and post operative follow-up were reviewed. Results: Seventeen cases (81%) of the myxomas originated in left atrium and four (19%) in right atrium. Most common symptom was that of intracardiac obstruction such as dyspnea or dyspnea on exertion (62%). Fatigue which accounted for most of the constitutional symptom found in 38% of the 21 patients while embolism accounted for 38%. In all patients, echocardiography was used for diagnosis and the diagnostic accuracy of echocardiography was 100%. All patient s received surgical treatment and immediate postoperative complications occurred in seven patients (33%). Among them, serious complications were found in two cases and one expired due to congestive heart failure. Follow-up duration ranged from 2 months to 15 year s. There was no recurrence or other problem in all patient s during the follow-up period. Conclusion: Although clinical suspicion is difficult due to the nonspecific presentation of myxoma, the diagnosis can be made easily with echocardiographic examination in all cases and surgical excision of myxoma may be curative with good long-term result.(Korean J Med 62:49-57, 2002)