How to Monitor Transseptal Puncture: A Consensus Statement of the Italian Society of Echocardiography and Cardiovascular Imaging

Interest in the anatomy of the interatrial septum (IAS) and the implications for a proper transseptal puncture (TSP) has risen in the past two decades along with the simultaneous evolution of left-sided transcatheter structural heart interventions. A comprehensive understanding of the anatomy of the IAS in relation with the therapeutic target, is essential for performing a safe and effective transseptal puncture. Intra-procedural echocardiography, transoesophageal and/or intracardiac, is recommended in all patients undergoing TSP because it provides fundamental insights into the septum anatomy and, furthermore, allows for tailored puncture. This document aims to describe the essentials of echocardiographic guidance of transseptal puncture (TSP).