Direct Visualization of External Outflow Graft Obstruction in Durable Left Ventricular Assist Device Using Transthoracic Echocardiography

External outflow graft obstruction (OGO) in durable left ventricular assist devices (LVADs) is a rare but critical complication. Detecting external OGO can be challenging because of its nonspecific symptoms and a wide variety of differential diagnoses. We report the case of a 45 year old man with LVAD admitted with complaints of recurrent syncope and frequent low-flow alarms. Laboratory tests and chest radiography revealed no specific findings. Transthoracic echocardiography via the left subcostal approach revealed an outflow graft compressed by a low-echo area within a bend relief. This finding led to a diagnosis of external OGO, which was consistent with what was observed on contrast-enhanced computed tomography. The patient underwent surgery and the gelatinous substance compressing the outflow graft was successfully removed. This case highlights the utility of transthoracic echocardiography as a noninvasive and effective method for detecting external OGOs, emphasizing its role as a valuable tool for the initial screening of patients with suspected OGO.