Multimodality echocardiography in structural heart disease: the evolving role of the interventional imager

Over the last decade, transcatheter structural heart interventions (TSHIs) have revolutionized the management of patients with structural heart disease (SHD), particularly those deemed high-risk or inoperable for conventional surgery. This rapid evolution has been propelled by innovations in both device technology and cardiovascular imaging, with echocardiography emerging as a cornerstone for procedural planning, real-time guidance and post-procedural assessment. This review outlines the expanding role of echocardiography across the spectrum of TSHIs, highlighting the importance of multimodality imaging, including three-dimensional transoesophageal echocardiography (3D TEE), intracardiac echocardiography (ICE) and fusion imaging techniques, for comprehensive structural evaluation and intraprocedural navigation. As the field continues to evolve, the demand for imaging specialists with procedural expertise is growing. Challenges remain in optimizing workflow, minimizing radiation exposure and enhancing image-guided precision. This review aims to outline the development of interventional imaging and promote best practices for procedural success and patient safety.