[Verse 1] Picture the plumbing, fresh conduit laid, graft running the road from the right ventricle to the lungs' parade, but four thieves lurk where the tubing bends, narrowing the exit right where the anastomosis ends. Distal suture line cinching tight like a drawstring purse, branch PA pinches where the vessel forks and curves, tube kinks over itself like a garden hose stepped flat, sternum closes down, squeezes the hood — gradient, just like that. [Chorus] N-I-C-K, that's the thief in the tube, Narrowing, Intimal growth, Compression, Kink — mark the groove, gradient climbing, right ventricle paying the toll, pressure stacks up, recovery crawls, slow, reintervention knocking before the month is through, N-I-C-K, four ways the flow gets screwed. [Verse 2] Bovine jugular, the valve from a cow's own neck, handles a small chest fine but carries a flaw to check, intimal hyperplasia creeping the suture seam, scar tissue blooming like moss choking a stream, distal anastomosis narrows, season by season, watch that graft close in — it's the textbook reason. [Verse 3] Back to the sizing chapter, the lesson won't erase, undersize the conduit, the kid outgrows the space, relative stenosis, the channel's turned too small, oversize the tubing, it buckles, starts to crawl, kinking in the chest like a hose left in the heat, both extremes of sizing make the right heart repeat its beat. [Verse 4] Catch it on the table, pressures told in real time, TEE painting flow, the gradient in the line, echo in week one, MRI down the road, mapping every branch where the stenosis likes to load, balloon catheter inflates, a stent props the branch wide, fix it in the cath lab — no sternotomy, no second ride. [Verse 5] Follow the kid through clinic, year after year, listen for the murmur creeping into the ear, serial echoes stacking, trending the climb, catching the thief early buys precious time, exercise testing, the right heart's report card, push too hard, too late, and the muscle turns to scar. [Bridge] Right ventricle grinding on a wall it can't push through, hypertrophy whispers what that gradient's gonna do, thirty millimeters climbing, the catheter don't lie, chase the number down before the muscle thickens high. [Chorus] N-I-C-K, that's the thief in the tube, Narrowing, Intimal growth, Compression, Kink — mark the groove, gradient climbing, right ventricle paying the toll, pressure stacks up, recovery crawls, slow, reintervention knocking before the month is through, N-I-C-K, four ways the flow gets screwed. [Outro] N-I-C-K, keep the thief in your sight, check the hood, check the kink, check the suture tight, balloon first, sternum last — that's the order of the fight.
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