In the last decade the great progress was made in the therapy of pulmonary arterial hypertension (PAH). Unfortunately, there is still lack of evidence-based data how to manage with pulmonary hypertension due to left heart diseases (PH-LHD). Approximately 60% of patients with heart failure with reduced ejection fraction (HFREF) develop PH-LHD and this condition is associated with a very poor prognosis. We report the case of 51-year-old man with a history of myocardial infarction, with HFREF who was previously disqualified from heart transplantation (HTX) due to PH. We added sildenafil (20 mg t.i.d.) to the standard therapy of HFREF in this patient. After 3 months of treatment with sildenafil we observed improvement in hemodynamic parameters, right and left ventricle performance as well as exercise capacity. Although we demonstrated the benefit of treatment with sildenafil in so called “no option” patients, further randomized trials are needed to confirm the advantage of sildenafil therapy in patients with PH due to HFREF. JRCD 2014; 1 (8): 27–31