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.