We report the case of a 26-year-old male with recurrent hemorrhagic cardiac tamponade occurring after initial management by needle pericardiocentesis and pigtail catheter drainage. As an alternative to open surgical pericardial fenestration, a percutaneous balloon pericardiostomy was performed with an 18 mm balloon catheter and over-the-wire insertion of a 16 F chest tube for 72 h of pericardial drainage. This non-surgical approach resulted in successful resolution of recurrent cardiac tamponade.