Changing concepts in the treatment of penetrating cardiac injuries.

: Thirty consecutive patients with penetrating wounds to the heart underwent surgery at the Medical College of Virginia Hospital. Classical signs of tamponade usually were not present. A precordial wound, positive pericardiocentesis, and shock were the most common indications of cardiac injury. Immediate operation is recommended for all penetrating injuries; pericardiocentesis is employed only for a diagnostic tool and for emergency relief of tamponade.