Primary tumors of the heart are rare and mostly benign. We report a case of a 72- year-old woman presenting with progressive dyspnea on exertion and both leg edema for 7 months. Serial examinations with echocardiography and computed tomography identified a cardiac tumor located along the posterior aspect of the heart. Video assisted thoracoscopic surgery was performed and the pathology revealed a lipoma. The patient's postoperative recovery was uneventful. A video-assisted thoracoscopic procedure with minithoracotomy can provide information on the differential diagnosis and therapy of cardiac subepicardial lipomas.