The burgeoning ranks of patients with heart failure, the limited number of organs available for heart transplant, and technological improvements have made ventricular assist devices (VADs) important therapeutic options for patients with acute and chronic cardiac decompensation. The increased use of VADs is paralleled by an increased use of transthoracic and transesophageal echocardiography to 1) assist in the selection of patients for VAD therapy and VADs to meet patient needs; 2) identify important anatomic considerations prior to implant; 3) guide placement of VADs; 4) diagnose the etiology of VAD dysfunction; and 5) guide the weaning from VAD support and the optimization of VAD device settings. This review discusses types of VADs and the uses of echocardiography in the care of VAD patients.