SINCE Larrey's first aspiration of the pericardial sac in 1829, and Rehn's first successful cardiorrhaphy in 1896, the mortality of penetrating wounds of the heart has steadily decreased. Large series attended by impressively low mortality have been published by advocates of pericardicentesis1-3 as well as by the proponents of direct surgical repair.4-7 The question of choice of treatment has been examined in our review of 98 patients with cardiac wounds seen at the Cincinnati General Hospital during the 30-year period between 1937 and 1967. Clinical Material The case histories of all patients arriving alive in the receiving ward of Cincinnati General Hospital with penetrating wounds of the heart have been studied with the exception of six patients with known cardiac injury whose records were lost. Two previous reports from this medical center are included in this account.8,9 Follow-up of the survivors has been difficult, as in most