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Objectives To determine the safety and value of esophageal radiography as a means of locating transseptal puncture. Methods 486 patients who underwent transseptal puncture were randomized into two groups. An esophagus radiographic method of locating tansseptal puncture site was applied in the study group( n = 243 ) and modified-Ross locating method was used in the control group ( n = 243 ). After successful location, transseptal puncture was made. We observed the success rate and incidence complications in the 2 groups.Results Left atrium impression in the study group was clearly seen. Nonetheless in 120 cases of control group,the left atria silhouette was not clearly visualised. The success rate of locating transseptal puncture site in the study group and control group were 100% and 50.6% respectively ( P＜0.001 ). The success rate of transseptal puncture in the study group and control group was 99.6% and 45.7% respectively ( P＜0.001 ). There were no complications associated with puncture in the study group and pericardial tamponade occurred in 1 control patient. Conclusions The esophagus radiographic method of locating transseptal puncture site is accurate,safe and simple to perform. Transseptal puncture has a high success rate with few complications.