PDE5A and pulmonary arterial hypertension: The early experience of Koestenberger and Hansmann (19) regarding patients with idiopathic PAH and PAH-CHD highlighted the threefold benefit of adding selexipag to standard dual (PDE5 inhibitor and ERA) therapy: it avoids CVL insertion for children and teenagers, helps stabilize the disease, and acts as a bridge to lung transplant.