Coarctation of the aorta (CoA) is a common congenital heart defect (Fig. 7) accounting for approximately 8% of all congenital defects. It probably results from extraneous ductal tissue that contracts following birth. Anatomically, it can occur before, at the level of, or after the ductus arteriosus, although adults with previously undiagnosed CoA almost always have postductal lesions. The most common way it is identified in adults is fortuitous discovery during secondary workup for systemic hypertension. Lower extremity and renal hypoperfusion lead to a hyper-renin state that might not abate, even after coarctation repair. In most patients, there is upper extremity hypertension and the development of collateral vessels around the coarctation to the lower extremity.