[Verse 1] Picture the wall between the chambers, thin or torn, Left side's stronger, higher pressure since the day you were born. Blood finds the easy road, sinistra to destra it will go, Left-to-right when the lungs' resistance stays down low. Size of the hole and the highways of resistance, that's the deal, Direction of the shunt is never random, it's mechanical, it's real. [Chorus] Il buco nel cuore, piccolo o grande — size decides, Da sinistra a destra, pressure guides the tides. Ascolta il soffio, listen to the murmur speak, Some are loud and lonely, some can make a whole heart weak. [Verse 2] Small and restrictive, tight as a keyhole, barely lets it pass, Pressure gradient screaming so it sings through broken glass. Maladie de Roger, French for "quiet child, loud chest," No symptoms, growing fine, but the stethoscope's impressed. Louder than a susurrus — that hush of wind through leaves — This murmur throws a fanfare while the patient lives at ease. [Verse 3] Moderate hole lets more escape, the left side has to cope, Atrium and ventricle stretched thin along the rope. Volume overload, the pump works harder, breath grows tight, Exertional symptoms, kids who tire before the night. Failure to thrive, the growth chart quietly falls behind, Feeding takes forever when the heart's this unrefined. [Chorus] Il buco nel cuore, piccolo o grande — size decides, Da sinistra a destra, pressure guides the tides. Ascolta il soffio, listen to the murmur speak, Some are loud and lonely, some can make a whole heart weak. [Verse 4] Large non-restrictive — no gradient, no wall to hide behind, Weeks four through eight, resistance drops, the failure starts to climb. Untreated years turn vessels thick, pulmonary disease will spread, Till the shunt reverses — Eisenmenger, cyanosis, blue instead. Rare now where the surgeons wait with patches close at hand, That's why we close them in infancy, before the tide can turn — understand? [Bridge] Don't call the small ones safe, the jet still cuts and wears, Endocarditis rides that stream, no matter how small the tears. Piccolo non vuol dire innocuo — small does not mean free, Every jet's a doorway bacteria might slip through and see. [Chorus] Il buco nel cuore, piccolo o grande — size decides, Da sinistra a destra, pressure guides the tides. Ascolta il soffio, listen to the murmur speak, Some are loud and lonely, some can make a whole heart weak. [Outro] Sinistra, destra, size and resistance write the score, Roger's murmur, Eisenmenger's blue — now you know the four. Il cuore ricorda, the heart remembers every seam, Close the gap in time before the tide reclaims the stream.
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