The necessity to replace the heart valves for cardiac tumors is low. Centofanti et al. reported less than 3% of valve replacement in 91 patients (10). We were forced to replace the valve only in two patients (2.2%), an aortic Lapatinib side effects valve replacement in a 39 years-old patients with multiple fibroelstoma and a mitral valve replacement in a 43 years-old patient with a papillary fibroelastoma involving the anterior mitral valve chords. In our experience the recurrence or new occurrence of atrial fibrillation (37.5%) during the follow-up is the major complication in particular in patients who had excision of the left atrial myxoma. During the follow-up period six patients were reoperated (6.6%). Three patients because of myxoma recurrence, two because of failure of the aortic valve repair and one because of failure of mitral valve repair.

The HMCM and angiomyolipoma are a rare benign heart tumors (14,15). Despite the benign histology, the location and the size of these tumors may complicate the surgical removal. In our patient with HMCM the complete resection was not feasible due to its location. We therefore opted for a partial resection just to resolve the mechanical obstruction of the left ventricular inflow. This choice is justified by the indolent grow of HMCM. Sometimes a partial resection may have a curative intent. Cardiac transplantation could be indicated in case of severely symptomatic disease not removable because of difficulty in maintaining the ventricular geometry (14). Cardiac sarcomas represent the common primary malignant cardiac tumor with prevalence of angiosarcoma.

Sarcomas are common in the third and fifth decades of life. Our patients had 2 angiosarcoma, 1 leiomyosarcomas, and 1 fibrosarcoma. The mean age was slightly above the average reported in literature (16). In our limited experience regarding four patients with malignant cardiac tumors we report mortality during the follow up period of 100% after a mean of 11.8 months after the operation. We would like to emphasize that all of our patients had at the time of the operation an extensive myocardial and pericardial infiltration, and they underwent surgery only to allow a secure and definitive histological diagnosis to guide the medical therapy or to perform palliative procedures such as pleuro-pericardial windows or a mass reduction.

In our experience the surgical resection is the treatment of choice for primary benign cardiac tumors because is safe, Carfilzomib curative and with low surgical mortality. After a radical operation the recurrence is rare in the long-term follow-up. We are in favor of an aggressive attitude to reduce the risk of clinical complication like embolism or cardiac failure. In contrast surgery was done only with a diagnostic and palliative intent in our patients with malignant disease.