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We report an interesting case presenting with progressive dyspnea and palpitations. The patient underwent multimodal imaging procedures consisting of two dimensional echocardiography, MRI, cardiac catheterization and also a three dimensional transesophageal echocardiographic reconstruction. All the investigations taken together helped us in finally arriving at accurate anatomical diagnosis of a coronary AV fistula from the left circumflex artery to the right atrium. The patient finally underwent a successful non-surgical closure using an Amplatzer device. The role of three-dimensional echocardiographic evaluation in defining the anatomy for planning the treatment is emphasized.