Reccurent Cardiac Myxoma Treated with Cardiac Transplantation: A Case Report

Abstract

<h3>Introduction</h3> Cardiac myxoma is the most common type of primary cardiac tumor. Typical clinical features are signals of mitral valve obstruction (dizziness, syncope and pulmonary congestion), constitutional symptoms and systemic embolization. Definitive treatment is surgical excision with favorable outcomes described. However, despite benign nature, myxoma recurrence has been reported in 2 -7% of cases. Cardiac transplantation (CT) is a modality of treatment rarely required for cardiac tumors, especially myxomas. <h3>Case Report</h3> We report a case of a 38-year-old woman, who discovered a cardiac myxoma in a diagnostic work-up after an ischemic stroke. She was submitted to surgical excisions in 1997, 1999 and 2013. Afternsecond surgery, she developed an atrioventricular block and required a definitive pacemaker. She had no family history of cardiac myxomas, neither signals of Carney complex. She was referred to our service for heart transplantation evaluation due to a forth myxoma recurrence. Chief complaint was severe dyspnea with symptoms at rest and physical examination was remarkable due to a grade 3 systolic murmur at the apex. Last transthoracic echocardiogram showed two large masses, one adhered to mitral valve ventricular side and the other fixed at the left ventricular apex extending through entire lateral wall and reaching left ventricular outflow tract (LVOT). Tumor was considered inoperable, and patient was listed for CT on August 4, 2020. Due to rapid tumor growth causing a drop on ejection fraction (EF of 40%) and invasion in LVOT, she was put on priority status and was submitted to CT on September 28, 2020. Surgery and post-operative course were uneventful and patient is well. <h3>Summary</h3> CT is the definitive treatment for refractory cardiovascular diseases from different etiologies. Despite considered benign, in rare cases, myxomas may recur after initial excision and progress to severe disease. This case report adds this scanty field in literature with one patient, which required CT with favorable short-term outcomes.