Through the right femoral vein, an 8-Fr Mullins-style introducer (62 cm Preface sheath; Biosense Webster) was placed in the superior vena cava, and a Brockenbrough 71-cm transseptal needle (BRK™; St. Jude Medical) was advanced through the introducer (a). TEE was performed in order to obtain a precise puncture of the fossa ovalis and to check the “tenting” phenomenon when the introducer was correctly pushed inside the fossa toward the left atrium (b). The transseptal puncture was performed in the lower limbus of the fossa ovalis and in its middle part by pushing the needle without advancing the introducer

The dedicated delivery system, 12-Fr Amplatzer TorqVue 45 × 45 Delivery Sheath (AGA, St. Jude Medical), was advanced in the left atrium over an Amplatz Super Stiff 0.035″ × 260 cm, short J tip guidewire (Boston Scientific). Atrium angiography was performed in RAO cranial view to size the LAA (a). TEE showed LAA ostium (transducer rotation at 87–105°) (b)