(A) Blood flow across the mitral valve was measured using echocardiography and scaled to a cardiac index of 3.0 [27]. (B) In this patient with severe heart failure, there was a minimal change in left ventricle geometry during the cardiac cycle. (C) Instantaneous flow pathlines in the two VAD configurations. (D-F) Initial 1.0 second simulations demonstrated minimal variability in wall shear stress, inlet pressure, or flow resistance. (G) Initial 1 second virtual ink washout study demonstrated that the apical configuration cleared approximately 2% more than the diaphragmatic configuration. (H) Visual representation of virtual ink simulation after 0, 0.5, and 4.0 seconds.