Abstract : The knowledge of the anatomy of the atria and interatrial septum permits different routes to approach the left atrioventricular valve. The Waterston's or Sondegaard's groove approach is the most frequently used, but other approaches such as Dubost'transseptal technique, vertical transseptal approach (Berreklouw-Guiraudon), biatrial inferior transseptal approach (Couetil) or Saksena's approach may be relevant in special situations. It is the purpose of this article to review the anatomic and technical basis of these different approaches and their respective merits