Pericardial effusion is the abnormal fluid accumulation in the pericardial space. This journal describes the management of massive pericardial effusion with pericardial adhesion. A 10-year-old girl with a history of failed arterial switch operation and post-ASD (atrial septal defect) closure using the pericardial patch and TVr De Vega procedure came with chest tightness. The transesophageal echocardiography showed massive pericardial effusion with collapsed right atrium and ventricle, severe tricuspid regurgitation, adhesion of cardiac apex with the pericardium. Urgent sub-xiphoid pericardiostomy was performed. Intrapericardial pigtail insertion was performed and produced 320 ml of fluid after 9 hours. The pericardial effusion may be due to severe pulmonary hypertension and pericardial injury syndrome. Open pericardiostomy should be considered if hemopericardium is suspected to prevent Pericardial Effusion.