Radiationless transseptal puncture

The transseptal puncture is commonly performed during cardiac interventions, although we have observed an increase in the number of procedures using this access to the left heart chambers (1). The clinical anatomy of the interatrial septum is difficult, and its lack of familiarity can cause serious complications. The true interatrial septum represents only approximately 20% of the entire interatrial septum area. Only the floor of the fossa ovalis and its immediate muscular inferior-anterior rim can be resected without leaving the cavities of the heart (2, 3). The relatively small area of approximately 140 mm2 can be punctured without complication; however, this would necessitate the use of catheter guidance techniques. The transseptal puncture is mainly performed under fluoroscopic guidance, resulting in exposure to ionizing radiation