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The use of transseptal puncture continues to rise given the increase in left atrial cardiac interventions. The authors review an anatomic approach to transseptal puncture incorporating multimodality imaging both pre- and intraprocedurally with stepwise escalation algorithms to ensure safe and efficacious large-bore transseptal puncture.Autoreactive T cells pose a constant risk for the emergence of autoimmune skin diseases in genetically predisposed individuals carrying certain HLA risk alleles. Immune tolerance mechanisms are opposed by b
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