Evaluation of pulmonary hypertension in chronic cardiac failure before cardiac transplantation is one of the major objectives of the pre-transplantation investigations. The risk of right ventricular failure, a poor short-term prognostic factor, is correlated with the level of pulmonary arteriolar resistance. Based on recent physiopathological data concerning the pulmonary circulation, advances on postoperative care and cardiopulmonary bypass techniques, this article aims to present the modern conception of evaluation of pulmonary hypertension, its reversibility in patients who are candidates for cardiac transplantation, and its treatment after the transplantation.