[Verse 1] Catheter whispers while the right ventricle labors, pressure climbing like a debt you can't dodge your neighbors, sixty millimeters mercury, that's the line in sand, for the symptomatic patient gasping, can't stand, but if the flow is low, drop the number, don't wait for the crash, severe pulmonary regurgitation, that backflow splash, counts on its own, no symptom needed, just the leak confirmed, echo doppler storytelling, lesson being learned. [Chorus] Sixty if you're breathless, severe PR's enough, eighty if you're silent but the muscle's getting tough, one-sixty end-diastolic, eighty on the squeeze, two-thirds systemic pressure, pediatric keys, write it, learn it, numbers like a drumbeat in your chest, thresholds built on cohorts, doing their very best. [Verse 2] Now the quiet patient, no complaints upon the chart, but the right ventricle's ballooning, swelling like a cart, overloaded, RVESVi eighty's the flag, RVEDVi one-sixty, volume starts to drag, exercise capacity falling though they swear they're fine, treadmill doesn't lie when the numbers cross the line, systolic function sliding, moderate TR or worse, RVSP past eighty, sustained arrhythmia's the curse, six warning signs to carry, memorize the view, any single one says consider, don't wait till it's overdue. [Chorus] Sixty if you're breathless, severe PR's enough, eighty if you're silent but the muscle's getting tough, one-sixty end-diastolic, eighty on the squeeze, two-thirds systemic pressure, pediatric keys. [Verse 3] Cross the ocean, AHA counts a different way, asymptomatic tetralogy, PR moderate today, need two or more red flags before you turn the page, one-sixty end-diastolic, eighty on the gauge, RVEF under forty-seven, or LV under fifty-five, a big aneurysm ballooning where the outflow tract's alive, QRS past one-sixty milliseconds, wide and slow, sustained tachyarrhythmia, or another lesion in tow, pick two from the list, that's your reasonable door, not one alone will do it, the heart demands you score more. [Verse 4] Down in pediatrics the rulebook shifts its stance, two-thirds of systemic pressure gets the conduit its chance, RV dysfunction, symptoms, same old reliable friends, but here's the twist that matters when the lesion type depends, stenosis earns forgiveness longer, pressure load's a slower burn, regurgitation sneaks in quiet, volume's harder lesson learned, only to a point though, don't let stenosis overstay, severe obstruction's still a reason to operate today. [Bridge] Every number that we chanted came from watching, not from trials, observational cohorts stretched across the miles, sixty, eighty, one-sixty, two-thirds in the mix, debated at the conference, nobody's fixed the fix, the open questions chapter circles back to timing's fight, memorize the guideline, but argue it tonight.
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