Background Simulation training is a useful adjunct to surgical training and education (SET) in Cardiothoracic Surgery yet training opportunities outside the Royal Australasian College of Surgery or industry‐sponsored workshops are rare due to high cost and limited training faculty, time, assessment tools or structured curricula. We describe our experience in establishing a low‐cost cardiac simulation programme. Methods We created low‐cost models using hospital facilities, hardware stores, abattoirs and donations from industry. Three workshops were conducted on coronary anastomoses, aortic and mitral valve replacement. Results Whole porcine hearts were sourced from local farms. Industry donations of obsolete stock were used for suture and valve material—stations constructed using ironing‐board, 2‐L buckets and kebab‐skewers. Suture ring holders were fashioned from recycled cardboard or donated. All participants were asked to complete pre and post simulation self‐assessment forms. Across three workshops, 45 participants (57.8% female) with a median age 27 (interquartile range 24–31) attended. Training level consisted of nurses (8, 17.8%), medical students (17, 37.8%), residents/house officers (6, 13.3%) and registrars (14, 31.1%). There were improvements in knowledge of anatomy (mean difference 18%; 95% confidence interval 12%–24%), imaging (16%; 10%–22%) and procedural components (34%; 28%–42%); and practical ability to describe steps (30%; 24%–38%), partially (32%; 26%–38%) or fully complete (32%; 28%–38%) the procedure. Conclusions Simulation‐based training in cardiac surgery is feasible in a hospital setting with low overhead costs. It can benefit participants at all training levels and has the potential to be implemented in training hospitals as an adjunct to the SET programme.

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A 62-year-old man with a heavy background of the right upper lobe squamous cell carcinoma was admitted with massive hemoptysis. Computerized tomography (CT) showed a large right upper lobe lesion with infiltration of mediastinum and airways. A right pulmonary artery pseudoaneurysm slightly bulging into the right main bronchus was seen, suspicious for a pulmonary artery bronchial fistula. A combined endotracheal and angiographic approach was done. The right pulmonary artery angiogram showed a now occluded neck to the pseudoaneurysm which was selectively cannulated. Framing and packing coils were deployed. Contrast was endoscopically noted without bronchial bleeding. As the coils were entering the lung parenchyma, packing back to the neck was done carefully. No new bleeding was noted. A bronchial stent was inserted 6 weeks later and one coil protruding into the bronchus was seen. A 3 month CT follow-up did not show any residual pseudoaneurysm. Patient died 3 months after initial procedure of his progressive illness. Only three cases of endovascular management of bronchial-pulmonary artery fistula reported with different techniques including pulmonary artery stenting. Our case is the only one reported treated with only coil embolization. Limited data are available regarding the risk of pulmonary embolism after stenting. Anticoagulation required after stenting increases the risk of bleeding in patients with severe hemoptysis. Management with coils only facilitates further management. This preserves pulmonary circulation in patients with already compromised respiratory function. Coil only embolization of uncommon pulmonary artery bronchial fistula is feasible and facilitates further management as it does not require anticoagulation in patient with recurrent bleeding.