Outcomes of multiple myxoma resections with carney complex

Abstract

Introduction: Carney Complex is a rare multiple endocrine neoplasia with cardiac myxomas being the most common cause of death among affected patients. One must consider how many heart surgeries a patient may acquire before the treatment itself becomes a significant risk factor. The use of an intra-aortic filter during cardiac surgeries is recommended, and heart transplantation treatment for Carney Complex patients is proposed. Presentation of case: A 24-year-old female presented with lightheadedness and was found to have a cardiac myxoma on the left atrium. The patient underwent myxoma resections on four separate occasions. The patient underwent a fifth cardiac myxoma resection. However, three days post-operatively, the patient experienced right-sided hemiplegia and imaging showed 99% left carotid artery occlusion. The patient was deemed unqualified for neurosurgical intervention and the patient died 5 days post-operatively. Discussion: Cardiac surgery can become detrimental with multiple surgical resections. With increased number of cardiac surgeries and increased risk for morbidities postoperatively, Carney Complex patients should have an intra-aortic filter to lower the risk of stroke. Conclusions: Intra-aortic filter usage is recommended during surgical resection of cardiac tumors to capture emboli before they travel into the systemic circulation. Heart transplant may prove beneficial to Carney complex cases, however neither the optimal number of cardiac operations nor the timing of heart transplantation in the disease are documented in literature, limiting evidence for solid therapeutic guidelines.