Table 3.

Mechanisms for Device Embolization

Mechanisms for device embolization
Inadequate Imaging	Underestimation of ductal dimension due to incomplete visualization of the ductus
Device Size	Implanted device is too small for the encountered anatomy
Ductal Spasm	Instrumentation of the ductus causes smooth muscle constriction leading to underestimation of ductal diameter
Device Malposition	Intraductal disc placement in larger infants (> 2 kg) Incorrect device orientation or shape
Delivery System	Anterior tension on the device by delivery wire. Delivery catheter preventing device to stay co-axial along the length of the duct
Operator related	Pushing delivery wire or catheter forward after device release. Prolonged time interval between device placement and release. Inadvertent unscrewing of the device from the delivery wire. Unfamiliarity with device sizing and placement guidelines
Patient related	Vigorous activity resulting in sudden increase in blood flow or intrathoracic pressure
Duct Morphology	Implanted device shape does not match shape of ductus