Abstract
Among the more spectacular wounds encountered by the surgeon are those involving the heart. Methods of managing these injuries have varied considerably since the first successful clinical cardiorrhaphy seventy years ago. It has been our policy to treat these patients primarily by pericardiocentesis with fluid and blood replacement and pulmonary reexpansion, reserving thoracotomy and cardiorrhaphy for those who fail to respond to such measures or whose condition again deteriorates after pericardial aspiration. Review of experience gained in the management of 197 consecutive patients in this manner during the period 1951 through 1965 continues to support this plan of treatment. Over-all mortality was 25.4 per cent, but this figure includes eleven patients who died before any form of treatment could be started and thirteen who experienced cardiac arrest prior to the onset of therapy but in whom thoracotomy was performed in an attempt at resuscitation. While thoracotomy and cardiorrhaphy should not be delayed when necessary, primary pericardiocentesis still appears to offer patients with penetrating cardiac injuries their best chance for survival.
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