Cardiac myxomas: a review of current treatment approaches and emerging molecular therapies

Abstract
Background
Cardiac myxomas are the most common primary cardiac tumors, predominantly located in the left atrium. These benign tumors can obstruct blood flow, cause embolization, or produce systemic symptoms like fever. Diagnostic tools such as echocardiography play a critical role in their identification, while surgical resection remains the primary curative treatment. Although recurrence is rare, it occurs more frequently in patients with genetic predispositions, such as the Carney complex. The risk of life-threatening complications such as embolism and sudden death necessitates prompt diagnosis and management. Despite the success of surgical treatment, recent advances have introduced minimally invasive techniques and novel molecular therapies, particularly for recurrent cases.

Main body
The epidemiology of cardiac myxomas highlights their rarity, with an incidence of 0.5–1 per million individuals annually. They are classified based on location, morphology, and whether they are sporadic or syndromic. Histologically, they originate from multipotent mesenchymal cells and present as gelatinous or solid masses. The genetic implicants, especially in familial cases, involve certain gene mutations, disrupting signaling pathways and leading to tumorigenesis. Diagnosis primarily relies on imaging, with transthoracic echocardiography being the first-line modality. Surgical resection, typically via median sternotomy, remains the gold standard treatment with a low recurrence rate. However, emerging molecular therapies, including gene editing, epigenetic interventions, stem cell therapy, and immunotherapy, offer promising avenues for managing complex or recurrent cases even though they are mostly in conceptual and preclinical phases. These molecular approaches target specific genetic and signaling pathways involved in myxoma formation and recurrence, and though they remain in experimental stages, the advent of gene therapy in oncology makes them the next best choice to watch out for.

Conclusions
While surgical resection remains curative in most cases, recurrence, particularly in familial syndromes, requires vigilant monitoring and innovative treatments. Emerging molecular therapies show potential in offering personalized treatment options, although they are still inchoate. Further research is needed to improve delivery systems and minimize the challenges associated with these therapies, paving the way for more effective management strategies.