Transseptal (TS) access was initially described in 1959 and since has been widely utilized for congenital and structural heart interventions. A thorough understanding of the anatomy is crucial for TS access (Fig. 8.1). The contemporary TS access stresses on not only understanding the anatomy but also on the knowledge of modern imaging modalities, alternative techniques for difficult or high-risk patients, site-specific puncture based on the type of procedure, and a systematic approach to management of complications (1). Advanced imaging such as fusion imaging may improve the site specificity of the TS access. There is a steep learning curve, and trainees may benefit from collaborating with other disciplines and doing simulator training. There is a renewed interest in percutaneous interventions for congenital and structural heart disease, and TS access remains an integral part of the skillset that is needed for safe and effective procedures.
Transseptal puncture steps (MP4 234056 kb)
The transseptal access can be closed by using a septal occluder (MP4 148507 kb)
TrSept puncture assistance in performing a transseptal puncture in complex cases (MP4 44661 kb)