We present a challenging case of truncus arteriosus type II repair in a 2-month-old, 3.3 kg infant admitted with heart failure and cyanosis. Right ventricular-to-pulmonary arterial continuity was restored using a right atrial free-wall autograft, while a neopulmonary valve was constructed from the right atrial appendage, providing an autologous valved connection. The patient also exhibited moderate-to-severe truncal valve stenosis and mild regurgitation, which were addressed with concomitant valve repair. The patient also had a single coronary artery.