[Verse 1] Picture the right ventricle, piping blood to lung, Conduit's a bridge built back when the patient's young, Half of these grafts, by year ten, they're done, Replacement or catheter fix — the fight's not won, Neonatal tubes, they thin out fast, Median three to five years, that's the math of the past, Small infant, big dream, but the pipe's a loan, Not a lifetime fixture — more like a stepping stone. [Chorus] Young, small, aortic, truncus, mis-sized — that's the list, Five horsemen of failure, better know they exist, Say it with me: age and weight, diameter tight, Aortic over pulmonary, sizing not quite right, Truncus, Rastelli, riding right along, Write it, learn it, sing the risk-factor song. [Verse 2] Let's break the five down, one line each to learn, Young age at implant — tiny vessels, slow to earn Room to grow, so the graft gets outgrown quick, Low weight babies strain the plumbing, make it sick, Small diameter conduit — narrow lane, more jam, Pressure builds up like a traffic gridlock slam, Aortic homograft's stiffer than its pulmonary kin, Calcifies faster, cracks the friable skin — Friable, meaning crumbly, prone to flake and break, That's your valve tissue when the biology's fake, Truncus and Rastelli bring harsher flow, Turbulent currents wear the conduit low. [Chorus] Young, small, aortic, truncus, mis-sized — that's the list, Five horsemen of failure, better know they exist, Say it with me: age and weight, diameter tight, Aortic over pulmonary, sizing not quite right, Truncus, Rastelli, riding right along, Write it, learn it, sing the risk-factor song. [Verse 3] Now the Goldilocks lesson — sizing's a craft, Z-score plus one to plus two, modest graft, Buys growth room without punishing the chest, But gross oversizing fails the durability test, Leaflets distort, redundant tissue folds, Sternum squeezes tight, the compression holds, Calcium creeps where the turbulence stirred, Undersized chokes flow — both extremes absurd. [Bridge] Bovine jugular vein, the quiet contender, Matches homograft years, a durable pretender, But watch the distal end, stenosis loves to grow, And endocarditis finds vegetation's furrow, Trade one risk for another, no conduit's divine, Every choice you make walks a risk-factor line. [Verse 4] So chart it, track it — this isn't one-and-done, Catheter balloons, melody valves, stage by stage, one by one, Lifetime management, Part Eight's the frame, Every conduit's clock ticking the same, Know the risk, predict the fall, Plan the next step before the echo call. [Chorus] Young, small, aortic, truncus, mis-sized — that's the list, Modest oversizing, z-plus-one's the twist, Not too big, not too small, find equilibrium's degree, Bovine or homograft, every pipe decays its own decree, Sing the risk-factor song, plan the lifelong days. [Outro] Half at ten years, three to five for the small, Know the risk factors, you'll outsmart the fall.
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