Structural heart disease (SHD) encompasses a wide range of congenital and acquired cardiac abnormalities, increasingly treated with transcatheter interventions. Echocardiography plays a crucial role in optimising these procedures, providing high-resolution imaging for pre-procedural planning, real-time guidance and post-intervention assessment. The shift from two-dimensional to advanced three/four-dimensional (3D/4D) echocardiography has significantly enhanced the visualisation of complex cardiac structures, improving procedural success and patient safety. The purpose of this review article is to provide an overview of the vital role of echocardiography in key structural heart interventions, including mitral transcatheter edge-to-edge repair, transcatheter aortic valve replacement, paravalvular leak closure, left atrial appendage occlusion and atrial septal defect closure. It highlights the integration of 3D/4D imaging and advanced Doppler techniques in refining procedural precision, optimising decision-making, and improving patient outcomes. The evolving field of interventional echocardiography continues to shape SHD management, making more minimally invasive treatments available to patients.