Atrial septal puncture technique in percutaneous transvenous mitral commissurotomy: mitral valvuloplasty using the Inoue balloon catheter technique.

Transseptal catheterization is a vital component of percutaneous transvenous mitral commissurotomy. Therefore, a well-executed transseptal catheterization is the key to a safe and successful percutaneous transvenous mitral commissurotomy. Two major problems inherent in atrial septal puncture for percutaneous transvenous mitral commissurotomy are cardiac perforation and puncture of an inappropriate atrial septal site. The former may lead to serious complication of cardiac tamponade and the latter to possible difficulty in maneuvering the Inoue balloon catheter across the mitral orifice. This article details atrial septal puncture technique, including landmark selection for optimal septal puncture sites, avoidance of inappropriate puncture sites, and step-by-step description of atrial septal puncture.