We report two cases of acquired coronary fistula in whom fistula flow and surgical repair were evaluated intraoperatively by contrast echocardiography. Surgical repair was carried out through the left atrium because of the associated surgical procedure on the mitral valve. Contrast echocardiography allowed easy identification of the fistula openings in the left atrium and intraoperative control of the efficacy of the surgical closure. Contrast echocardiography is an ideal tool for the intraoperative diagnosis of effective interruption of a coronary fistula.