Transseptal Puncture Technique in the ERA of Structural Heart Disease

Transseptal puncture is an essential technique for the success of multiple structural heart interventions. The transseptal puncture maneuvers have undergone only minor modifications, but the introduction of refined tools and imaging, particularly the utilization of echocardiographic guidance, with either transesophageal or intracardiac echo, has increased the safety of the procedure and allowed a precise site-specific puncture that markedly increases the success of some of the contemporary structural heart procedures. The role of 3D echocardiography, computed tomography, and fusion of different imaging modalities, particularly fluoroscopy and transesophageal echocardiography, has been increasing exponentially. This chapter reviews the transseptal techniques, the different tools available, imaging, and tips and tricks for the procedure.