A transseptal insertion device is provided including device housing, a pusher slidably disposed in the device housing and a guide element extending from the pusher. The device housing is configured to be inserted into the right atrium of a patient's heart and the guide element can then be advanced from the device housing and against the cardiac septum to facilitate stable puncturing of the cardiac septum by a needle carried by a catheter inserted through the device housing, to provide access to the left atrium. The guide element can be formed as a webbing or ring. The pusher and/or guide element can optionally be inflatable.
