This is a 31 year old with a 4.5 cm aneurysm at the root of the aorta and a coarctation of the aorta just distal to the left subclavian artery. She presented with shortness of breath, severe hypertension, chest pain, and claudication. The case consisted of open repair of an aortic aneurysm as well as a posterior pericardial ascending to descending aortic bypass to treat the complex coarctation of the aorta.