• Although cardiac injuries are rare but cause high mortality. • Up to 20% of the injured to the hospital alive. • The key to success is early diagnosis and ambulatory surgery. • Echocardiography help early diagnosis of damage • Midline transsternal incision is the choice in patients with a degree of heamodynamic stability. • Anterieur left Thoracic incision is the choice in unstable patients and is often done in the Emergency Department and as part of recovery .