Iatrogenic phrenic nerve injury in early-onset recurrent cardiac myxoma: a case report

Introduction: Cardiac myxomas (CMs) are the most common benign primary heart tumors. CMs can present with diverse symptoms including embolic events and neurological signs. Diagnosis relies heavily on imaging modalities like transthoracic echocardiography. Surgical excision is the definitive treatment due to the high risk of embolism. Case presentation: A 19-year-old woman presented with dyspnea, palpitations, and dizziness. Echocardiography revealed a right atrial mass. Surgical excision via sternotomy confirmed a 2 cm CM. Eighteen months later, the patient presented with symptomatic recurrence. Following a redo sternotomy, she developed a permanent iatrogenic phrenic nerve injury, resulting in diaphragmatic paralysis and significant respiratory morbidity. Discussion: This report details a 19-year-old woman presenting with non-specific symptoms, who was ultimately diagnosied with CM. This case is noteworthy due to the patient’s young age – as CMs typically occur in middle-aged individuals – the sporadic recurrence of the tumor, and the associated post-surgical complications. We outline the diagnostic pathway for CMs identification and emphasize the rarity of recurrence in sporadic cases following initial resection. Additionally, we discuss the iatrogenic phrenic nerve injury and its long-term impact on the patient’s respiratory health. Conclusion: CMs management requires precise surgical strategy and long-term follow-up, particularly in redo cases. This report highlights the significant risk of iatrogenic phrenic nerve injury during re-intervention, emphasizing the need for specialized perioperative care to optimize clinical outcomes.