Figure 21.

Determining the site for transseptal puncture. (A) Transesophageal Echocardiogram with bi-plane/X-plane imaging of the interatrial septum with labeled portions of the septum: inferior (INF), superior (SUP); posterior (Post) and anterior (Ant); (B) transseptal puncture through the atrial septum >4 cm above the mitral annulus to approach a degenerative mitral valve; (C) transseptal puncture through the atrial septum at 4 cm above the mitral annulus to approach a functional mitral valve.