Penetrating cardiac injuries provide the surgeon until nowadays with a challenging problem due to a high mortality rate. Depending on the mechanism of trauma and the time interval less than 20% of the patients with severe wounds of the heart reach the hospital alive. Methods of managing these wounds are controversial. Pericardiocentesis has more a diagnostic than a therapeutic value. Emergency thoracotomy will help reduce the mortality even in agonal and decompensation patients. With respect to the literature and 31 own cases the diagnosis, the operative management and the results will be discussed.