Objective: The assessment of flow characteristics inside ventricular assist devices by magnetic resonance imaging techniques may provide insight into the mechanisms underlying the high rate of thromboembolic events after implantation of a ventricular assist device. Furthermore, these investigations may form the basis to optimize the device's design and its need for anticoagulation. The purpose of this study was to integrate a clinical routine ventricular assist device into a flow circuit with realistic geometric and pulsatile inflow conditions. Combination with flow-sensitive magnetic resonance imaging at 3 T permitted the detailed analysis of local and global 3-dimensional flow dynamics in a realistic environment. Methods: A commercially available ventricular assist device was integrated into a magnetic resonance-compatible flow circuit. Flow-sensitive 3-dimensional magnetic resonance imaging was performed to measure time-resolved 3-directional flow velocities in the entire device. Advanced computer-aided 3-dimensional flow visualization methods were used to derive a comprehensive picture of flow dynamics within the ventricular assist device system. Results: On the basis of the ventricular assist device model system, magnetic resonance imaging, and flow visualization, the first 4-dimensional functional magnetic resonance imaging analysis of flow characteristics inside an operating clinical routine ventricular assist device chamber system is reported. Detailed visualization of flow patterns and local changes in flow characteristics were successfully performed and revealed locally accelerated, vortical, and helical flow regions inside the geometry of the device. Conclusions: Complex flow patterns such as vortex formation and locally accelerated flow demonstrate the potential of the presented method to further deepen the understanding of complex and regionally different flow characteristics inside ventricular assist devices.