Cardiac myxoma in Carney complex rate at 80-90 bpm. A median sternotomy was performed at the incision site of the previous surgery. After detaching the tight pericardial adhesion, a cardiopulmonary bypass was performed. Three myxomatous nodules in the left atrium and one myxoma in the right atrium were removed. A 20 mm myxoma in the lateral wall of the right ventricular outflow tract was removed through the main pulmonary artery immediately below the pulmonary valve. The operation lasted 7 hours and 30 minutes and the cardiopulmonary bypass lasted 2 hours and 10 minutes. After surgery, the patient was transferred to the intensive care unit where he was under observation for a day. The patient stabilized, so two days after he was transferred to the general ward. Post-operative echocardiography showed no remnant mass in the right ventricular outflow tract, but showed borderline concentric left ventricular hypertrophy with an ejection fraction of 69.2%. Case 2 A 16-year old male patient who was 172 cm in height and 73 kg in weight, and whose mother was diagnosed with Carney complex, had removal surgery of myxoma in the left atrium three years ago. He was diagnosed with Carney complex after presenting with a thyroid nodule, adrenal gland tumor, and sertoli cell tumor in the testicular gland. He also underwent left orchiectomy and left adrenalectomy two years ago. Afterwards, he had been under ambulatory follow-up monitoring for the thyroid nodule, pituitary adenoma, and Cushing’s syndrome. Pre-operative echocardiography confirmed a 34 × 24 mm sized myxoma in the posterior mitral valve leaflet of the left atrial posterior side, which is a rare location for myxomas Vol. 61, No. 6, December 2011 to occur (Fig. 3 and 4). It also showed mild eccentric aortic regurgitation with an ejection fraction of 66.2%. Sellar magnetic resonance imaging showed a 1 cm sized pituitary adenoma on the fossa floor. Before the operation, the department of endocrinology and neurology were consulted. Because results of a quadruple test showed no abnormality in the pituitary functions, it was discussed that there would be no problem to continue on with myxoma removal surgery. The electrocardiography showed sinus bradycardia with sinus arrhythmia, and the chest radiography showed no active lung lesions. Upon arrival on to the operating room, the blood pressure was 130/80 mmHg, and the heart rated was 78 bpm. The electrocardiography, pulse oxymeter, and arterial blood pressure were monitored as fentanyl 200 μg, etomidate 20 mg, and rocuronium 50 mg were administered for anesthetic induction. The patient was a Cormack-Lehane grade I, allowing easy endotracheal intubation. Intra-operative blood pressure was maintained at 140-160/60-80 mmHg and heart rate was 80 bpm. The surgery was performed as a median sternotomy, and with a cardiopulmonary bypass a 3 cm friable mass with a broad stalk in the posterior wall of the left atrium was removed through the right atrium. After surgery, the patient was transferred under sedation to the intensive care unit for observation. The patient stabilized, and two days later he was transferred to the general ward. Discussion Both patients from the two cases described above were brothers with Carney complex. Their mother also had a history of numerous cardiac myxoma removal surgeries for Carney complex. At the molecular level, Carney complex is known to be Fig. 3. Pre-operative transesophageal echocardiogram of the patient from case 2 showed two myxomas in the left atrial posterior wall. M: cardiac myxomas, LA: left atrium, AS: atrial septum, MV: mitral valve, IVS: interventricular septum, LV: left ventricle. Fig. 4. Pre-operative chest computed tomography of the patient from case 2 showed a myxoma in the left atrium. M: cardiac myxoma. 530 www.ekja.org