Abstract: Objective To review our experiences with diagnosis and treatment of 6 cases of penetrating injury to the left ventricle. Methods Six patients were admitted to the emergency department 0.5 to 3 h after the injury, all with shock and 3 with obvious pericardiac tamponade. All the patients received immediate thoracotomy for repairing the ruptured left ventricle, subpericardial window and pericardiocentesis, with also blood autotransfusion. Results All patients survived the operations. One patient required reexploration because of hemorrahge in the chest and two presented ST-segment changes in postoperative ECG, and one had nonspecific intraventricular conduction delay with T-wave inversion. Conclusions Penetrating injury to the left ventricle is manifested by low blood pressure and signs of pericardial tamponade. Immediate thoracotomy to relieve the tamponade and effective hemostasis can be critical for management of such patients.