Primary pericardial mesothelioma represents less than 1% of all malignant mesotheliomas. These tumors are very rare, difficult to diagnose, and have a poor response to established treatments. Common clinical presentations include constrictive symptoms, cardiac tamponade, and cardiac failure. Surgical resection can be curative in early stages and for localized tumors, and pericardiectomy and chemotherapy are often used as palliative approaches. We present the case of a 54-year-old woman who has so far survived 4 years after a primary resection of a pericardial mesothelioma and was referred with myocardial and aortopulmonary window recurrences for further treatment.