Transcatheter valve intervention are more advanced and also successful evolution of conventional cardiac surgery. The first step in cardiac surgery was performed on the beating hearts in the case of digital or instrumental mitral commisurotomy. Although open heart surgery stays always the “Gold Standard” procedure, because it is crucial in understanding via direct “Visus” the valve diseases. Transcatheter technologies takes advantages from the open heart technique using catheter based instruments for elderly and high risk patients. Transcatheter mitral valve commisurotomy was the first surgical therapy converted to transcatheter one in the 1980. Today with a new art of transcatheter technology, with more clinical efficacy and safety is this “The Procedure of Choice” with a faster recovery and less peri-operative pain. But although it seems the TAVI procedure is more effective at elderly high risk or non-operable patients. The German TAVR registry shows that at low risk population, the observed mortality & morbidity is higher than that population by the EUROSCORE. The key and the crucial point at the introduction a new clinical technology is the optimal “TRANSLATION” to the daily human practice. The new interventional technology have to be supported – after previous excellent results of animal and all clinical phase studies - by “Clinical Evidence!!!”. In this technology imaging is the crucial factor in the selection & in the screening process, to guide patients to the right size and art of device selection, as well as in playing a fundamental role during procedures to guide the implant safely and effectively.