Coarctation is a stenosis of the descending aorta at the level of the duct insertion. This causes hypertension in the upper limbs and head, and hypotension in the abdomen and lower limbs. If undetected this can lead to left ventricular failure, pulmonary hypertension and hypertensive encephalopathy. Anaesthetic management of the stenosis is to avoid tachycardia and keeping an adequate blood pressure for renal perfusion. Inotropes might be needed, depending on ventricular function. Associated cardiac lesions will need additional considerations.