The proper management of coarctation in infancy is still poorly defined. Frequently, the high mortality rate in this age group has been attributed solely to the complex intracardiac lesions associated with coarctation and a rather defeatist attitude has been adopted with regard to treatment. Seventy-three patients under 2 years of age with coarctation of the aorta were reviewed. Congestive heart failure was present in 88%. The patients were divided into three groups: (1) Coarctation with or without patent ductus. There were 34 patients. Twenty-one were treated medically and there was a mortality rate of 71%. Thirteen were treated surgically and there was a mortality rate of 15%. (2) Coarctation with or without a patent ductus and an associated potentially correctable intracardiac defect. Fourteen were treated nonsurgically and all died. The remainder were treated by operation and 45% survived. (3) Coarctation and associated complex intracardiac malformations. All died. This review indicates that the high mortality rate of symptomatic coarctation of the aorta in infancy is significantly decreased by early operation.