The echocardiographic-fluoroscopic fusion imaging tool is able to acquire imaging data from both fluoroscopy and transesophageal images and co-register and align them in the three-dimensional space and time by putting onto the same coordinate system. In this way the soft tissues that are well visualized by echocardiography and the metallic materials (catheters and devices), better imaged by fluoroscopy, are displayed in the standard fluoroscopic projections in a hybrid image in real time. In this review, we describe the basic technical aspects and its main applications in transcatheter structural heart interventions.