The management of hemodynamic instability caused by a growing pericardial effusion and cardiac tamponade requires the prompt evacuation of the effusion. This can be done either by pericardiocentesis or a surgical procedure. However, long-term prognosis of the patient and the risk for recurrences are not determined by the type of the initial procedure selected, but rather by the underlying etiology and the physician’s ability to treat the causal disease. Percutaneous balloon pericardiotomy is a palliative, alternative approach for the management of recurring pericardial effusion, applied so far mainly for recurrences of the neoplastic pericardial effusion [1]. The procedure is more complex than pericardiocentesis.