Coarctation of the aorta is characterized by narrowing of the aorta just distal to the left subclavian artery. It has a male preponderance and is frequently associated with hypoplasia of the aortic arch and isthmus. Other associated conditions include bicuspid aortic valve, dilated aortic root, mitral valve abnormalities, and intracranial aneurysm.1–2 Bicuspid aortic valve is the most common associated lesion occurring in about half of the patients. Coarctation of the aorta imposes a pressure load on the left ventricle, resulting in proximal systemic hypertension that may persist after surgery if correction is performed beyond 5 years of age.3 Patients who have surgical correction for coarctation are at risk for long-term complications including death.1,4–5 There were 87 late deaths, with a mean age of death of 38 years in 646 such patients followed up at the Mayo Clinic. The most common cause of death was coronary artery disease, followed by sudden death, heart failure, stroke, and ruptured aortic aneurysm.5 Regular follow-up with aggressive treatment of risk factors for coronary artery disease is clearly necessary in these patients.