**4.2 Experience at the Montreal Heart Institute**

At the Montreal Heart Institute, iPGI2 (Hache et al., 2001; Hache et al., 2003) and inhaled milrinone (Lamarche et al., 2005; Lamarche et al., 2007) are commonly administered to patients when PH and RV dysfunction occur before or after cardiac surgery. Oral sildenafil and iNO are also used in refractory cases in the ICU. Administration by inhalation has the advantage of selectively reaching well-ventilated regions of the lung and thus avoiding undesired decreases of systemic pressures. Future strategies may include the combination of currently available drugs and improvement of methods of administration for current drugs.
