INTRODUCTION
Transseptal left heart catheterization is used for both diagnostic purposes, such as measurement of the transmitral gradient with native or prosthetic valve stenosis, and therapeutic procedures, such as percutaneous mitral valve commissurotomy, electrophysiologic ablation requiring access to the pulmonary veins, and percutaneous mitral valve repair. The technique can be performed with a major complication rate of under 1% in experienced centers. Transseptal left heart catheterization involves vascular access via the venous system (usually a femoral vein), insertion of a catheter into the right heart, needle puncture of the atrial septum in the fossa ovalis, and advancement of a catheter into the left atrium over a dilator. Specific techniques may vary, and an excellent recent review with images of techniques for various transseptal procedures can be found in reference 1, Alkhouli et al.

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