Systems and methods for creating a puncture between aorta and the left atrium

A method of puncturing from an aorta into a left atrium using a puncturing device. The method involves a step of accessing a carotid artery and advancing a puncturing device through the carotid artery into an aorta. Advancing a sheath and a dilator over the puncturing device through the carotid artery and into the aorta such that a puncturing tip of the puncturing device is aligned with a distal tip of the sheath and a distal tip of the dilator, forming a puncturing assembly. Positioning the puncturing assembly at a target site within the aorta to gain access to a left atrium of a heart. Tenting a tissue between the aorta and the left atrium using the puncturing assembly. Creating a puncture through the tissue by advancing the puncturing device such that a channel between the aorta and the left atrium is formed.