Left ventricular aneurysm with herniation through the chest wall.

Cardiac herniation is a rare event associated with a high mortality rate. It is typically seen with blunt trauma to the chest or after a pneumectomy. Signs and symptoms include arrhythmia, myocardial ischemia, and hypotension.

Improving patient care in cardiac surgery using Toyota production system based methodology.

Background: A new cardiac surgery program was developed in a community hospital setting using the operational excellence (OE) method, which is based on the principles of the Toyota production system. The initial results of the first 409 heart operations, performed over the 28 months between March 1, 2008, and June 30, 2010, are presented.

Methods: Operational excellence methodology was taught to the cardiac surgery team.