Pericardiocentesis and removal of the fluid in patients with pericardial effusion can cause several complications. Though rarely, rapid removal of effusion may alter the fluid dynamics resulting in circulatory complication. We describe a 40-year old male with malignant pericardial effusion associated with germ cell tumor. Twelve hours after massive drainage of fluid by pericardiocentesis, marked but transient left ventricular failure developed. After he was treated with mechanical ventilator support and inotropic agents, his cardiac function was normalized in 2 weeks. Gradual removal of pericardial fluid under hemodynamic monitoring is advisable in patients with large amount of pericardial effusion.