Acquired left ventricle-to-right atrium (LV-RA) communications are a known complication of valvular heart surgery. Previous reports have described the clinical features and diagnosis using cardiac catheterization. We report two cases of acquired LV-RA fistula that occurred after mitral valve replacement. Particular emphasis is placed on the diagnosis using transthoracic and transesophageal echocardiography, thus obviating the need for cardiac catheterization before repair.