Patent Ductus Arteriosus

"A tube?"

Auntie Irene looked puzzled. Gret held out his hand to indicate the length of his forearm, then made a circle with his left thumb and index finger to show how thick it should be.

"About this thick and this long... It needs to be hollow..."

"You can just listen directly!" Auntie Irene waved her hand with a hearty laugh. "Avril's so little. Besides, you watched her grow up!"

Gret broke into a cold sweat. He never wanted to press his ear against someone's chest to listen to their heartbeat again! If he had any choice, never again!

Seeing how determined he was, Auntie Irene searched beneath the kitchen counter and found a pitch-black hollow tube. She washed it and handed it to him. Gret examined the thing in his hands. It was longer than his entire arm, black with soot at one end and marked with scorch stains. It was clearly a fire bellows.

...All right.

He'd make do with it for now. If he got the chance later, he'd have a stethoscope made...

Gret composed himself, put one end of the bellows to his ear, and pressed the other against Avril. Though he'd said he was listening to her breathing, the end of the bellows slowly moved until it reached the point where her heartbeat was strongest. He held it firmly in place and listened, holding his breath. Every now and then, he shifted it slightly. The longer he listened, the graver his expression became.

There was a murmur at the apex of the heart.

He moved to the pulmonary valve area, at the second intercostal space along the left edge of the sternum. The diastolic murmur was even clearer—a continuous, machine-like murmur.

As he moved toward the aortic valve area, the murmur grew fainter. He could barely hear anything around the tricuspid valve. After listening all the way around the heart, he moved to the area below the left clavicle. The clear, machine-like murmur sounded again...

A continuous, machine-like murmur could be heard during diastole at the second intercostal space along the left edge of the sternum and below the left clavicle. It radiated widely.

Combined with the differential cyanosis, frailty, weakness, and seasonal cough she'd shown earlier, the diagnosis was highly likely...

Patent Ductus Arteriosus.

One type of Congenital Heart Disease. Mild cases might cause few symptoms over a person's lifetime. Severe cases could lead to Pulmonary Hypertension, Heart Failure, and eventually death.

Gret squeezed his eyes shut. He patiently listened to her lungs, confirmed that her breathing sounded normal, and lowered the bellows. Then, with a glimmer of hope, he turned to ask Auntie Irene:

"Auntie, has anyone ever had a look at Avril's condition? What did the priest say?"

His grave expression had clearly frightened the others. In the lamplight, Auntie Irene froze for a moment, then forced a smile and sent Avril off to bed. Afterward, she let out a long sigh.

"The Bishop said Avril's just weak. She should rest more and be careful not to catch cold... If we want to treat her until she's like everyone else, we'd need a very high level of Divine Arts, and he can't perform them..."

Did they really think she was just weak?

Gret felt sad, but also a little relieved. Maybe it was better that they knew nothing more. Sometimes, ignorance was a kind of bliss... What could they do, even if they knew it was congenital heart disease?

Heart disease had been incurable for a long time. Even after surgery began to develop, the heart remained off-limits to medicine for many years. The Austrian doctor Theodor Billroth, later hailed as the "Father of Surgery," had pronounced this "curse" on heart surgery:

"To operate on the heart is to profane the art of surgery. Anyone who attempts heart surgery will end up disgraced and ruined." (Note 1)

There was no life support, no cardiopulmonary bypass, not even the most basic means of stopping bleeding, sterilizing, or anesthetizing a patient. Under the current conditions, attempting heart surgery would be tantamount to murdering the patient.

Better to let Uncle Karen, Auntie Irene, and the others go on living in ignorance, without ever knowing.

Gret barely managed to convince himself. Then he looked back at Avril. Her complexion had improved considerably now that she'd stopped coughing. The faint purple tinge on her toes had faded, and they were pink again.

To Gret, that faint pink was the most beautiful color in the world.

Thank goodness! The cyanosis only appeared when she coughed violently and became oxygen-deprived. Her skin wasn't blue under normal circumstances!

With Patent Ductus Arteriosus this mild, she might still have more than ten years before it progressed to Pulmonary Hypertension, severe heart failure, and death—if they were lucky!

Gret breathed a sigh of relief. He forced down his unease, smiled as he reassured little Avril, then chatted with Uncle Karen and Auntie Irene about this and that before taking his leave. The moment the door closed behind him and the house disappeared into darkness, Gret shut his eyes and clenched his fists.

Patent Ductus Arteriosus could be treated.

In his previous life, he'd seen countless patients with this condition and referred some to his colleagues in cardiology.

It wasn't incurable, and treatment wouldn't bankrupt the family.

For a child like little Avril, all she'd need in his previous life was Interventional Surgery. An Occluder would seal the duct between the aorta and pulmonary artery, and the entire procedure would take only an hour and a half. Her heartbeat would sound normal that same day, and within a few days she'd be running and jumping around again.

But that was easier said than done—

They'd need an electrocardiogram to determine whether her heart had defects; an X-ray to rule out other diseases; an Echocardiogram to identify the condition; and Cardiac Catheterization to assess pulmonary vascular resistance and blood flow, rule out other abnormalities, and confirm that she was eligible for surgery.

They'd need a Guidewire, no thicker than 0.88 millimeters and no thinner than 0.45, to be guided by X-rays up through the patient's femoral artery until it entered the heart.

They'd need an Occluder made of superelastic Nickel-Titanium Alloy, lined with a polymer biofilm, which the Guidewire would carry to the defect in the ductus arteriosus. Then they'd need to control the Occluder as it opened to seal the gap.

Of course, they'd also need a Contrast Agent pure enough to avoid causing blood clots when injected into a vessel. They'd inject it into the bloodstream and use X-rays to show the direction of blood flow, confirming whether the surgery had succeeded...

Every single part was a culmination of the cutting-edge technology of modern medicine and industry. From the Industrial Revolution to the Electrical Age and the Internet Age, countless years of advances in science, industry, and medicine had bridged the chasm between life and death, turning what had once been incurable into something ordinary.

But now, he, Gret Nordmark, had nothing.

This was another world.

There were no catheters, Guidewires, or Occluders. No Echocardiograms or X-rays. No anesthesia, no blood transfusions, no contrast agents...

How was he supposed to snatch little Avril's life back from the hands of death?

Divine Arts were no longer an option. The Bishop had said he couldn't treat her, which clearly meant that lower-level Divine Arts couldn't handle congenital diseases. Magic, then... Magic...

Could magic produce ultrasound waves? Could it make an electrocardiogram? Could it summon a sufficiently fine Guidewire and send it into the heart to repair the defect?

Could magic... let him see the mysteries hidden inside the human body?

Gret didn't know. But he did know that, starting tomorrow, he would open the door to magic. If he worked hard enough, if he had enough imagination, anything was possible!

In ten years, he would accomplish all of this!

Uncle Karen, Auntie Irene, little Avril—

Wait for me!

***

Note 1:

Quoted from Legends of Cardiac Surgery.

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