Structural heart disease intervention has evolved significantly over the last decade. Medical and interventional approaches to the management of patients with valvular AS depend on accurate diagnosis of the cause and stage of the disease process. For aortic valve disease, patients have access to both transcutaneous valve replacement and surgical valve replacement. For mitral valve disease, patients have access to Mitraclip repair and traditional mitral valve repair or replacement. Indications for all of these have evolved as outcomes have been found to be comparable between the transcutaneous and open procedures. For left atrial appendage closure, procedures have evolved as well. Most of these procedures rely on high resolution imaging and technology for success. Interventions targeting tricuspid valve abnormalities are also receiving increased attention.