The surgical management of truncus arteriosus poses a constant challenge for the cardiac team treating the patient. A correct diagnosis, surgical therapy and postoperative management are crucial for the survival of the patient. Almost 30% of the patients show an abnormal number of leaflets in the truncal valve, the majority being quadricuspid valves. Additionally, around 25% of the patients show some degree of truncal valve incompetence. We demonstrate an effective way to reconstruct incompetent, quadricuspid valves with good postoperative outcome.