{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T02:03:08Z","timestamp":1784253788841,"version":"3.55.0"},"reference-count":46,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T00:00:00Z","timestamp":1784160000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Transseptal puncture (TSP) is a critical technique for accessing the left atrium in various structural and electrophysiological cardiac procedures. Originally introduced for diagnostic catheterization in the mid-20th century, it has evolved into a cornerstone of modern interventional cardiology. This article was designed as a targeted narrative review, rather than a systematic or comprehensive review, and synthesizes selected peer-reviewed evidence spanning 1955 to 2025, retrieved through a targeted literature search. We explore the anatomical foundations of TSP, its historical development, and modern refinements such as radiofrequency-assisted puncture, balloon septoplasty, and fluoroless or image-fusion-guided access. Clinical applications\u2014including mitral valve interventions, left atrial appendage closure, and decompression during extracorporeal membrane oxygenation (ECMO)\u2014are reviewed alongside safety considerations and complication management strategies. Advances in imaging modalities, including three-dimensional echocardiography and computed tomography, have enhanced precision and safety. Because of the narrative design, the review emphasizes clinical relevance, procedural applicability, and evidence synthesis without formal risk-of-bias scoring or quantitative evidence grading. Overall, TSP demonstrates a high success rate and low complication profile when performed with appropriate imaging and operator expertise. Ongoing innovation in technique and technology continues to expand its utility across cardiac disciplines.<\/jats:p>","DOI":"10.3390\/life16071179","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T00:55:59Z","timestamp":1784249759000},"page":"1179","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Transseptal Access to the Left Atrium: A Narrative Review of Techniques, Indications, and Device Innovations"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5500-1620","authenticated-orcid":false,"given":"Andrei Mihnea","family":"Rosu","sequence":"first","affiliation":[{"name":"Department of Cardiology, Prof. Dr. Agripa Ionescu Emergency Hospital, 077015 Balotesti, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-1225-097X","authenticated-orcid":false,"given":"Theodor Georgian","family":"Badea","sequence":"additional","affiliation":[{"name":"Department of Radiology, Prof. Dr. Agripa Ionescu Emergency Hospital, 077015 Balotesti, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florentina Luminita","family":"Tomescu","sequence":"additional","affiliation":[{"name":"Department of Radiology, Prof. Dr. Agripa Ionescu Emergency Hospital, 077015 Balotesti, Romania"},{"name":"Department of Radiology, Carol Davila University of Medicine and Pharmacy, 022328 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuel Stefan","family":"Radu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Prof. Dr. Agripa Ionescu Emergency Hospital, 077015 Balotesti, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria-Daniela","family":"Tanasescu","sequence":"additional","affiliation":[{"name":"Department of Semiology, Emergency University Hospital, Carol Davila University of Medicine and Pharmacy, 022328 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7611-005X","authenticated-orcid":false,"given":"Eduard George","family":"Cismas","sequence":"additional","affiliation":[{"name":"Department of Cardiology, \u201cSf. Ioan\u201d Emergency Clinical Hospital, 061344 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oana Andreea","family":"Popa","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Prof. Dr. Agripa Ionescu Emergency Hospital, 077015 Balotesti, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1016\/0002-9149(59)90347-9","article-title":"Transseptal left atrial puncture: New technique for the measurement of left atrial pressure in man","volume":"5","author":"Ross","year":"1959","journal-title":"Am. J. Cardiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1016\/S0096-5588(20)30047-7","article-title":"Technique for Transseptal Catheterization of the Left Atrium: Preliminary Report","volume":"37","author":"Cope","year":"1959","journal-title":"J. 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