Percutaneous balloon pericardiotomy was reported by Palacious et al in 1991. From 1996-2000, we utilized this procedure as the initial treatment for 17 patients at West Virginia University Hospital in Morgantown with cardiac tamponade who had a high likelihood of recurrence of pericardial effusion. Primary pericardiotomy was successful after the initial procedure in 82% (n = 14) of these patients, so it appears to be an effective non-surgical procedure for patients at high risk for re-accumulation of pericardial effusions. In addition, our comparison at this institution revealed that primary percutaneous pericardial window creation is significantly less costly than pericardiocentesis followed by surgical pericardial window creation.