About 5% of patients with cardiac myxoma have a family history of the disorder¹, and in this group the tumour is most likely to recur after surgery².

At the age of 21 a woman underwent thoracotomy for removal of a left atrial myxoma. Her mother and sister had both died suddenly, at ages 31 and 19; necropsy in the sister had revealed a left atrial myxoma. 12 years after operation, the patient complained of shortness of breath, palpitations, and a persistent ache and paraesthesiae in the right fore-arm and fingers. On examination she had a systolic murmur at the left parasternal edge, and investigations showed reappearance of the tumour, this time in the right atrium in the region of the fossa ovalis. A sternotomy was performed and a 10 cm long and 1 cm diameter mass of myxoma arising from the limbus was widely excised with the fossa ovalis. The defect was repaired with Dacron. 11 years later, recurrence of the tumour was discovered in the right ventricle with involvement of the tricuspid valve, after the onset of bilateral claudication. A sternotomy was performed again, and an enormous tumour was found in the right ventricle with involvement of the tricuspid valve and several papillary muscles. The tumour was excised with the tricuspid valve, which was replaced with a Carpentier—Edwards xenograft. A 2 cm tumour in the left atrium was also excised, the defect being repaired with a patch. The left ventricle was explored but no tumour was found on the mitral or aortic valves. 16 years later a cardiac murmur was heard on routine follow-up and transoesophageal echocardiography revealed a 3 cm lesion, this time on the posterior mitral valve leaflet. The tumour was very mobile and was flipping in and out of the left atrium during diastole and systole (Figure 1). Sternotomy was done again, the tumour was excised and the mitral valve was preserved. Histology confirmed myxoma tissue on each recurrence.