CASE PRESENTATION: A 30 year old female with no significant past medical history was seen in an outpatient cardiology clinic for dyspnea on exertion. Initial Vitals: BP 140/80, Pulse 84, RR 18, afebrile. Physical examination revealed regular s1/s2 with new III/VI pansystolic murmur with clear lungs. An echocardiogram (ECHO) showed large mass in right ventricle near right ventricular outflow tract. Emergent CT surgery was done with excision was performed for myxoma. Patient also underwent tricuspid valve replacement (TVR) with pericardial closure. A repeat ECHO two days later showed a clot in right ventricle. Patient was started on intravenous heparin later switched to warfarin and was discharged to follow up as outpatient. A follow up ECHO showed recurrence of mass in right ventricle for which cardiac magnetic resonance imaging (cMRI) was done. It showed that the mass was a combination of recurrent myxoma and clot and was very extensive involving a major portion of the right ventricular free wall. Patient was referred to a transplant center for possible heart transplantation. After extensive discussions, it was decided to attempt redo surgery for resection of the recurrent mass. The pathology of the mass showed myxoma again. All the outpatient workup was negative for a clotting disorder.