Venous excess ultrasound score (VExUS) is a recently described ultrasound-based scoring system that quantifies systemic congestion using Doppler flow indices of the hepatic and portal vein in addition to inferior vena cava assessment. There are many potential and emerging applications of this modality. We discuss the case of a severely congested heart failure patient presenting for urgent non-cardiac surgery where VExUS parameters were used to monitor and guide his decongestive therapy postoperatively.