You're confusing managed C++ with C++/CLI. The latter tries to introduce additional constructs to C++, so that it can partake in the CLR object model - and there you get all those limitations like no multiple inheritance. But you can, in fact, compile any random C++ code to IL - just run cl.exe with /clr:pure. The only thing that doesn't work in that case is setjmp/longjmp; everything else is available.

If you want to see it for yourself, take some .cpp file, and compile it with cl.exe /clr:pure /O2 /FAs. The latter switch will dump the IL assembly into the corresponding .asm file. Or you can inspect the output with ILSpy etc. You'll see that it compiles native C++ types down to CLR structs with no fields, but with explicitly set size (via StructLayout.Explicit); and then uses pointer arithmetic to access field values.