[Verse 1]
Aorta to bicaval, that's the standard line,
two cannulas in the cavae, superior and inferior entwined,
or aorto-right-atrial when the anatomy's kind,
single venous catheter, simpler to find.
But when the chest is hostile, scar tissue thick as stone,
re-entry is a gamble, don't you go in alone,
femoral vessels calling, the groin becomes the door,
cannulate before you open, bypass before the saw.
Vacuum-assisted drainage for the tiniest chest,
small veins can't gravity-drain their best,
negative pressure pulling blood where it's suppressed,
protect the little pump while you're putting it to the test.
[Chorus]
Herz schlägt weiter — kein Klemmen heut',
Luft im Herzen, das bereut,
Erst das Loch, dann roll die Welle,
Blut und Wärme, Zelle für Zelle.
(No clamp today, the heart beats on,
seal the hole before the air is gone.)
[Verse 2]
No intracardiac work, no need to cross the clamp,
beating-heart conduit swap, skip the cardioplegic stamp,
heart keeps its rhythm, perfusion never stops,
but first you gotta check what's open at the top —
PFO lurking, or a VSD unsealed,
air in the right heart's an embolus congealed,
cross to the system side and stroke waits in the wings,
close it, exclude it, before the bypass sings.
Rule written in red: seal the shunt first,
beating heart's a privilege, not a hedge against the worst.
[Chorus]
Herz schlägt weiter — kein Klemmen heut',
Luft im Herzen, das bereut,
Erst das Loch, dann roll die Welle,
Blut und Wärme, Zelle für Zelle.
[Verse 3]
But when you're baffling the LVOT, rerouting the flow,
or chasing a VSD patch that's starting to go,
the aortic cusp unhappy, tricuspid leaflet torn,
coronary glued to conduit, dissection newly born —
then arrest the muscle, still it cold and slow,
del Nido single dose, one gift of potassium woe,
or blood cardioplegia cycling warm to red,
feeding the myocardium while the surgeon's ahead.
Thirty-two to thirty-four, a mild hypothermic drift,
or run it normothermic, give the engine a lift.
[Verse 4]
Pediatric circuit's thirsty, don't dilute too far,
prime the tubing with blood, keep the hematocrit on par,
small volume, big consequence, dilution is the thief,
balance oxygen delivery, bring the red cells relief.
After the pump falls quiet, fluid hides in the seams,
ultrafiltration wrings it out, conventional through the stream,
modified after bypass, concentrate what's thin,
raise the hematocrit, let the clotting factors in.
[Bridge]
Kein Klemmen, keine Eile — Sicherheit zuerst,
Luft und Loch, die Regel, die man immer übt,
Kalt oder warm, das Herz entscheidet mit,
Blut im Schlauch, Leben jeden Schritt.
[Chorus]
Herz schlägt weiter — kein Klemmen heut',
Luft im Herzen, das bereut,
Erst das Loch, dann roll die Welle,
Blut und Wärme, Zelle für Zelle.
[Outro]
Cannulate smart, protect the beat,
know when to arrest, know when to repeat,
ultrafilter the water weight,
myocardium saved — that's the surgeon's fate.