Background <p>A pulmonary artery catheter (PAC) is widely used to manage various health conditions during cardiac surgery. However, it can cause rare but life-threatening complications such as pulmonary artery injury. Although surgical treatment is often required for pulmonary artery injury caused by a PAC, detailed reports of the surgical management of this complication are lacking. We present a case of PAC-induced pulmonary artery injury that occurred during cardiac surgery and was successfully managed with surgical treatment without pulmonary resection.</p> Case presentation <p>A 76-year-old woman with severe heart valve disease underwent replacement of the aortic and mitral valves and surgical repair of the tricuspid valve using a PAC. Massive bleeding into the airway occurred during withdrawal from cardiopulmonary bypass. Fluoroscopic contrast injection through the PAC identified a PAC-induced tear in the left pulmonary artery as the cause of the bleeding. Opening of the left fourth intercostal space was performed without changing the supine position of the patient. Bleeding was successfully controlled by ligating the damaged branch of the pulmonary artery (A6c) and suturing the roots of the peripheral pulmonary arteries (A9 and A10) without performing lung resection. The patient recovered without complications and was discharged in good condition.</p> Conclusions <p>Although PAC-induced pulmonary artery injury is associated with a high mortality rate, the patient survived cardiac surgery with lung preservation in the supine position.</p>