Cardiovascular computed tomography (CT) enables a non-invasive assessment of a multitude of cardiac ailments notably coronary, structural and congenital heart diseases, as well as valvular disorders and cardiomyopathies. Technological advancement, including machine learning and generative artificial intelligence (AI), has revolutionized the application of cardiac CT not only as a diagnostic tool but also to guide interventions. CT-derived fractional flow reserve (FFRCT) enhanced the diagnostic accuracy of CT coronary angiography (CTCA) to detect obstructive coronary artery disease (CAD), determine plaque extension, volume and composition, quantify risk of Major Adverse Cardiovascular Events (MACE) and plan percutaneous coronary interventions (PCI) or Coronary Artery Bypass Grafting (CABG). Additionally, CTCA can provide scoring tools to improve procedural success, and minimize complications of complex coronary interventions, such as chronic total occlusion (CTO) interventions. Moreover, cardiac CT aids in pre-procedural planning and assessment of interventions like transcatheter aortic valve implantation (TAVI) and left atrial appendage occlusion (LAAO). Its ability to provide comprehensive anatomical and functional information makes it indispensable in guiding complex structural interventions and ensuring optimal patient outcomes. This review explores the evolving role of cardiac CT in coronary and structural heart disease interventions, highlighting its technological advancements, clinical applications, and future directions in cardiovascular care.