Since its introduction by Swan and coworkers in 1970, pulmonary artery catheters (PACs) have been widely used to assist in the care of critically ill surgical or medical patients, assuring the continuous measurement of pulmonary artery pressure and cardiac output. Nevertheless, several complications including arrhythmias, venous thrombosis, balloon rupture, intracardiac knotting of the catheter, pulmonary artery injury, catheter misplacement, and cardiac perforation have been repeatedly reported after PAC insertion. Atrial perforation has been reported in the literature as a complication of central venous access, which is generally diagnosed radiologically or postmortem. Here, a case of right atrium perforation after PAC insertion via the right internal jugular approach, which was promptly diagnosed because of the open-chest nature of the surgery, is reported.