Pericardial puncture drainage was attempted in five patients with pericardial effusion under the guidance of real time two-dimensional echocardiography (ultrasonic cardiotomography). The needle fixed to the scanner probe was inserted from the anterior chest wall under the observation of ultrasound images. After the needle was placed into the pericardial space, then the drainage catheter was introduced according to the Seldinger technique. The image of the needle should be appropriately monitored from the site of puncture as near as possible because the pericardium is so close to the anterior chest wall. Both mechanical and linear sector scanners were used in this study, and linear type was proved to be useful for this purpose. It was concluded that the pericardial puncture under the guidance of ultrasonic cardiotomography is safer and reliable compared to the conventional blind puncture technique.