Opinion differs among surgeons of wide experience on the management of cardiac tamponade. Although pericardicentesis was suggested as early as 1649,23 only during the last two decades has it been widely adopted. The value of aspiration has been emphasized by Bigger, Blalock, Elkin, Cooley, and others,4-6,9,12,15,20,22 and this therapeutic measure is now generally accepted as an adjunct to the treatment of cardiac tamponade. Some surgeons14,17 feel that, although aspiration may be lifesaving, a thoracotomy should be performed in almost all cases to allow closure of the wound in the myocardium and complete evacuation of the blood and clots from the pericardium. These surgeons contend that residual blood and clots may result in the development of constrictive pericarditis. In addition, attention is called to the possibility of cardiac aneurysm developing from failure to suture the myocardial wound. The treatment of cardiac wounds in this hospital prior to 1940