A 57-year-old woman developed cardiogenic shock secondary to right ventricular failure in the postoperative setting. Because of clinical suspicion of pulmonary embolism, the patient was taken to the operating room for emergency thrombectomy. The patient improved dramatically after sternotomy and pericardiotomy, with no evidence of thrombus being found. Sternotomy followed by pericardiotomy may have a role in the treatment of acute right ventricular failure with small pericardial effusion.