The surgical treatment of an aortic coarctation requires a resection of the stenotic area and direct suture of the aorta. An extended mobilization allows an enlargement of a hypoplastic distal aortic arch. In ductal dependent circulation, the distal aortic arch can be enlarged with a patch before tackling the coarctation itself. Postsurgical aortic arch stenoses often require a surgical intervention. Our preferred method is an anatomic correction with an enlargement plasty either on the concavity or on the convexity of the arch, depending on the local anatomy. An extra-anatomic bypass is also an option.