A patient suffered from recurrent pericardial effusions following heart transplantation. Repeated pericardiocentesis and insertion of pericardial drains could not resolve the problem and therefore surgical intervention was necessary. The procedure was performed as a minimally invasive thoracoscopic pericardial fenestration. Four months postoperative the patient was without recurrences. This method of pericardial fenestration after heart transplantation has been used for the first time.