A direct visualization catheter adapted for transseptal crossing includes at least an outer member, and inner member, a transparent balloon member, and an imaging element. The outer member includes a tubular body extending from a proximal end to a distal end and defines a first lumen there through. The inner member is slidably disposed within the first lumen of the outer member and includes an elongate body with a distal end. The transparent balloon member is coupled between the distal end of the outer member and the distal end of the inner member such that the shape of the transparent balloon member is adjusted by sliding the inner member and the outer member relative to each other. The imaging element is disposed within the balloon member.
