Recurrent multiple cardiac myxomas

The recurrence of cardiac myxoma after a surgical excision is a rare condition. The mechanism responsible for the recurrence remains unclear. Multifocal growth of a benign myxoma or malignant transformation, inadequate resection, intraoperative implantation or embolization, familial disposition, and the abnormal DNA ploidy pattern play an important role in development of recurrent myxoma.

We report the case of a 24-year-old female with recurrent multiple cardiac myxomas. She had an abortus 2 months ago. The patient had undergone a resection of left atrial and right ventricular myxoma with extension to the right pulmonary artery 8 years ago. The preoperative echocardiographic examinations revealed recurrent left atrial and right and left ventricular myxomas. The patient underwent a redo-surgery and, in addition to a large myxoma in the right ventricle with involvement of the tricuspid valve and anterior papillary muscle, three myxomas including both myxomas originating at the top and the base of the posterior papillary muscle, respectively, the other myxoma between both papillary muscles in the posterior wall of the left ventricle, and 2 more small myxomas including 1 in the interatrial septum and the other on atrial surface of anterior mitral annulus were found in the left ventricle and atrium. The myxomas were successfully excised through a transmitral approach with a combined bi-atrial incision. The tricuspid valve and mitral valve were repaired with annuloplasty. She had an uneventful postoperative course and no residual myxoma was found by echocardiography.

We think that a long-term follow-up by echocardiography in all patients after the resection of myxoma is advised for an early detection of any recurrence (Fig. 5, Ref. 9).