Forty infants under 3 months of age underwent repair of coarctation of the aorta (CoA) during an 8-year period. Preoperatively, 55% of the patients received intensive circulatory and/or respiratory care, and surgical relief of CoA was effected within 24 hours of diagnosis. The last 38 patients were managed by simple repair of the CoA in patients with significant VSD (Group II), with the addition of pulmonary artery banding in patients with complex cardiac lesions with VSD, or patients with incremental risk factors in Group II. There were no intraoperative deaths, one (2.6%) postoperative, and four (11%) late deaths in the last 38 patients. Only one (2.9%) showed signs of recurrence in 34 patients followed for 10 to 104 (mean 46) months. Improvement in the survival rate in this study can be attributed to: (1) aggressive preoperative care, (2) early noninvasive diagnosis and operation, (3) refinement in the surgical technique, and (4) appropriate use of pulmonary artery banding.