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In truncus arteriosus, the embryologic truncus fails to properly divide in-utero resulting in the pulmonary, aortic and coronary arteries arising from a single ascending portion of this trunk. This condition is usually fatal within the first year of life without correction. Over the past two decades, there has been a dramatic expansion in access to diagnostic echo cardiography in Kenya and greater ability to diagnose congenital heart diseases. We present the case of a 43 year old male from western Kenya, newly diagnosed with heart failure due to truncus arteriosus. This case highlights the value of echo-cardiography in Kenya, and supports the need for surgical and interventional cardiac services to grow in tandem with these diagnostic capabilities.