Abstract
Transseptal puncture (TSP) has evolved from a diagnostic technique into an essential step in contemporary cardiovascular interventions, including catheter ablation, balloon mitral valvuloplasty, left atrial appendage closure, and transcatheter structural heart procedures. Successful TSP requires not only safe access to the left atrium but also optimal puncture site selection to facilitate subsequent interventions. This state-of-the-art review summarizes the anatomical principles, procedural techniques, imaging guidance, technological advances, and strategies for preventing and managing complications. Recent developments in transesophageal and intracardiac echocardiography, radiofrequency-assisted puncture, and dedicated transseptal devices have improved procedural precision and efficiency. Nevertheless, a thorough understanding of interatrial septal anatomy, accurate identification of anatomical landmarks, careful needle manipulation, and confirmation of left atrial access remain fundamental to procedural safety. Drawing on extensive Vietnamese experience with balloon mitral valvuloplasty, the review also highlights the enduring value of simplified fluoroscopy-guided techniques. Future priorities include individualized procedural planning, standardized training, appropriate integration of advanced imaging, and systematic assessment of procedural outcomes to improve safety and effectiveness.
