[Verse 1] There's a runnel of red between the chambers, born the night the septum failed to seal, Qp over Qs is the number that matters, one-point-five to two tips the wheel. Watch the left side stretch, watch the atrium swell, feel for that thrill still under your palm, a susurrus, soft as parchment turning — that's the murmur's whisper, never quite calm. Symptoms creeping, failure to thrive, pulmonary pressure climbing the wall, is this a whisper or a shout in disguise? That's the question before you do anything at all. [Chorus] Shunt, threat, wait, fit, gate, five small gates before you operate, ask the heart what it's trying to say before you cut, before you weigh. Shunt, threat, wait, fit, gate, five decisions, don't be late. [Verse 2] Is a leaflet sagging toward the tunnel, prolapsing down to the aortic door, watch a whisper turning into thunder, regurgitation knocking, wanting more. Guard against endocarditis camping, vegetations on a turbulent stream, double-chamber right ventricle cramping, a pressure trap dividing the dream. Sometimes a channel sneaks left into atrium, LV to RA, a Gerbode disguise — threats can lurk though the shunt looks modest, read the anatomy, never the size. [Chorus] [Verse 3] Small muscular holes in the young and the hopeful close on their own more often than not, perimembranous, wrapped in a pouch for a blanket, aneurysm tissue sealing the spot. But age is a tide that won't be rewound now, the older the patient, the slimmer the chance, so weigh what nature might still be allowed before you go reaching for scalpel and lance. [Verse 4] Rims of tissue, the distance from valve, decide if a device can nest in that hole — too close to the aorta, too near the conduction, surgery answers where catheters stall. A patch of pericardium, stitched in silence, or a nitinol disc, released with care — anatomy chooses the tool for the mending, not comfort, not habit, but what's really there. [Verse 5] Echo windows charting the changes, years of follow-up, patient and slow, some holes heal soft in their own quiet ranges, some need a hand to help the blood flow. Listen closely, the story keeps turning, each visit a verse in the same steady song, the heart holds its secrets, patient, unyielding, teaching us where we still might be wrong. [Bridge] But before you touch a single thread, ask if the lungs still let blood through — pulmonary resistance climbing ahead turns left-into-right to blue-on-blue. Eisenmenger waits behind that gate, once it swings open, it won't undo, so measure the vessels before it's too late — the window closes if you don't. [Chorus] [Outro] Shunt, threat, wait, fit, gate, say it slow before you operate, five small questions, one small hole, holding the rhythm of the whole.
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