We report an infant who had tetralogy of Fallot, hypoplastic pulmonary arteries, and membranous pulmonary atresia who underwent successful perforation of the atretic valve and subsequent balloon pulmonary valvuloplasty. Because of the inability to access the pulmonary arteries via a patent ductus arteriosus, two-dimensional echocardiography was used to confirm wire position prior to perforation. The branch pulmonary arteries initially measured 1.5 mm in diameter and enlarged to 2.8 mm immediately after valvuloplasty. Four months postprocedure, the patient underwent a successful repeat balloon pulmonary valvuloplasty. The pulmonary arteries had grown to approximately 6 mm in diameter. Although it is a rare occurrence, patients with tetralogy of Fallot and membranous pulmonary atresia can be dilated with successful growth of the pulmonary arteries.