Percutaneous valve interventions is a rapidly evolving field of cardiovascular therapy. New technologies for aortic valve replacement and mitral valve repair are now developing in addition to the well established techniques of balloon valvuloplasty for the treatment of mitral and aortic stenosis. A number of devices are under development and investigation, and are going to be used in humans in the next few years to treat valve disease as an alternative to surgery in selected clinical conditions. Several clinical benefits are expected to be linked to the PVI as compared to conventional surgery: less pain and trauma for patients, shorter length of stay in the intensive care unit and hospital, and faster recovery from the procedure. As these techniques are less invasive, they will be potentially performed in an earlier stage of valve disease, when the clinical benefits are more probable. However, several demanding issues are going to challenge the dissemination of PVI in the next coming years, including: technology development and application, regulatory issues for new devices and new indications, training of the operators and development of the clinical applications for such therapies, evaluation of the results and comparison with the surgical standards. The present review focuses on the opportunities as well as on the hurdles of PVI, with the awareness that the exact role for these techniques has to be determined yet, and is strictly depending on the results of the ongoing clinical trials, which will become available in the next coming years.