The utilization of transcatheter-based interventions for the management of valvular heart disease is increasing at a rapid pace on a global scale. Additionally, left atrial appendage closure device implantation for stroke prevention in patients with atrial fibrillation is becoming more prevalent. Transesophageal echocardiography (TEE) plays an essential role in proper patient selection and for real-time guidance of these procedures. In this chapter, we review the role of 2D and 3D TEE in transcatheter aortic valve replacement (TAVR), edge to edge mitral valve repair, and left atrial appendage closure with the Watchman device. For each procedure, we discuss the most important echocardiographic views, measurements, and considerations for pre-procedural patient and device selection, intra-procedural guidance of device placement and positioning, and post-deployment monitoring of complications.