[Verse 1] Twelve millimeters, stitched in when you're small and new, Fixed-diameter tube — it can't grow up with you. Cardiac output climbs as the body gets tall, Same old pipe now too narrow for the flow, that's all. Somatic outgrowth, no stretch left to borrow, Today's perfect graft is tomorrow's bottleneck sorrow. [Chorus] Cuatro caminos pa' fallar el conducto, Creció, calcificó, rechazó, se rompió — ¡escúchalo! No creció contigo, mi amor, se quedó atrás, Four ways down, pero el corazón sigue más. [Verse 2] Dead tissue can't fight the mineral tide, Dystrophic calcium creeping along the inside. Younger hearts churn calcium faster, turnover's steep, So the kids calcify quicker while the leaflets can't keep. Aortic homografts catch it worse than the rest — Chalky, stiff, crunching under the chest. [Chorus] Cuatro caminos pa' fallar el conducto, Creció, calcificó, rechazó, se rompió — ¡escúchalo! Calcificado, duro como piedra fría, The graft turns to stone before the end of the day. [Verse 3] Donor HLA waving flags the body don't know, Antibodies muster, T-cells join the show. Panel-reactive levels climb after the graft goes in, Sensitize the system — remember that, it's a sin For later transplant lists, cross-match gets tight, El cuerpo rechaza lo ajeno en silencio esta noche. [Verse 4] Sternum presses down, the conduit gets pinned, Kinks where the distal anastomosis begins. Neointimal peel creeps over Dacron, bovine too, Narrowing the lane like scar tissue glue. Pseudoaneurysm balloons at the proximal hood, Endocarditis chews leaflets — vegetations where blood should've flowed good. [Chorus] Cuatro caminos pa' fallar el conducto, Creció, calcificó, rechazó, se rompió — ¡escúchalo! Mecánico o microbio, el tubo no perdona, Pressure finds the weak spot, la sangre no perdona. [Bridge] Stenosis tightens, regurgitation leaks wide, Sometimes both outlaws ride side by side. That mixture writes the letter the right ventricle reads next, Hypertrophy or dilation — the chapter's already text. Es la mezcla, mi gente, la que decide el destino, Stenosis, regurge, o los dos en el mismo camino. [Verse 5] Echo every season, watching gradients rise, Catheter confirms what the Doppler implies. Reoperation looms when the numbers won't hold, Valve-in-valve technology buys time, we're told, But transcatheter patches can't fix a graft too small — Surveillance imaging tracks the silent downfall. Four failure roads mapped out on every chart, Growth, calcium, immunity, mechanics — know them by heart. [Outro] Four roads, one failing tube, the body keeps score — Growth, calcium, immunity, and the mechanical floor. Creció, calcificó, rechazó, se rompió, Remember the four, and you'll know how it goes.
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