Structural heart disease refers to non-coronary cardiovascular disease processes and related interventions. The last 10 years has seen tremendous advances in both the understanding of these processes and the therapeutic modalities aimed to treat them. Technology continues to evolve and clinical trials are ongoing to help delineate the appropriate role these therapies will play. Inherent challenges exist in training physicians in structural heart disease. Ultimately, credentialing societies and training programmes will emerge to help assure expertise within the cardiovascular community. This review focuses on the scope of structural heart disease, summarizes some of the current and future technologies available, highlights inherent challenges pertaining to structural heart disease and outlines future directions the field may take.