A 65-year-old man who underwent mitral valve plasty was readmitted the hospital with severe dyspnea and hypotension 7 months after operation. Results of computerized tomographic scanning and transesophageal echocardiography showed pericardial thickening and left ventricle out flow stenosis due to a constrictive epicardial peel. At the time of reoperation, he underwent both pericardial and epicardial stripping. He demonstrated only limited hemodynamic improvement after pericardial stripping. His hemodynamic status improved markedly after epicardial stripping. His postoperative course was uneventful and no complication was recognized. Epicardial stripping is important in patients with epicardial sclerosis.