Computed tomography (CT) scanning has recently assumed a first-pillar role in the preoperative planning of patients undergoing transcatheter structural heart procedures (e.g., transcatheter aortic valve implantation, TAVI; MitraClip; Triclip; left atrial appendage occlusion, LAAO). A careful preprocedural assessment is crucial for achieving the best possible result, and, currently, CT represents the paramount technique to obtain morphological data on cardiac and vessel structures, thus allowing to choose the most appropriate vascular approach, the type and size of devices, and all the required steps to meet procedural expectations. The image reconstruction accuracy also provides information to predict potential complications such as misplacements and leakages. This review aims to describe the role of CT in the decision-making approach of patients undergoing structural heart interventions and expand the clinicians’ understanding of the benefits and drawbacks of this imaging technique.