A 56-year-old man underwent orthotopic heart transplantation (Htx) for dilative cardiomyopathy. The postoperative course was uneventful despite the appearance of pericardial effusions during the first 6 months, which required repeated drainage therapy. Six months postoperatively a pericardial window was created using a thoracoscopic approach via the right pleural cavity. The course after this intervention was uncomplicated and there was no recurrence of the pericardial effusion during 18 months of follow-up.