Background <p>Papillary fibroelastoma (PTF) of the left ventricle is rare, and surgical approach should be well considered preoperatively. We report two surgical cases of left ventricular PFE by two different approaches.</p> Case presentation <p>First patient was a 74-year-old female who presented with palpitation. An echocardiogram revealed a pedunculated mass lesion in the apex of the left ventricle Rivaroxaban was prescribed for one month because cardiac tumor with mobile thrombus was suspected, and surgical resection was indicated because the morphology of the mass did not change on the follow-up echocardiogram. Second patient was an asymptomatic 82-year-old female with history of atrial fibrillation. A screening echocardiogram incidentally revealed a pedunculated mass lesion of the septum of the left ventricular outflow tract. Surgical resection was indicated due to the mobility of the mass. In both patients, surgery was performed via median sternotomy. In first patient, ventricular tumor was approached via left atriotomy and Cooley retractor was deeply placed onto the anterior mitral leaflet to expose the tumor on the apex. In second patient, the tumor was approached via aortotomy and rolled sterile tape measure was inserted into the aortic annulus, which maintained the aortic cusps wide open to expose the interventricular septum. Both tumors were diagnosed as PFE by histopathology.</p> Conclusions <p>An attempt to create a patient-tailored surgical approach is required for the surgical resection of left ventricular papillary fibroelastoma depending on the tumor location.</p>