Patent Ductus Arteriosus

"A tube?"

Auntie Irene asked, confused. Gret extended his hand, gesturing the length of his forearm, then circled his left thumb and index finger together to indicate thickness:

"This thick, this long... it needs to be hollow..."

"You can just listen directly!" Auntie Irene waved her hand generously. "Avril is so small. Besides, you've watched her grow up!"

This... Gret broke out in a cold sweat. He never wanted to press his ear against someone's chest to listen to their heart again! If there was any other way, he never wanted to do it!

Seeing his determined persistence, Auntie Irene rummaged in the kitchen and found a long, hollow, pitch-black tube. She washed it and handed it over. Gret took it and looked at it. The thing was longer than his entire arm, one end covered in charcoal black with many burn marks. It was clearly a blowpipe.

...Fine.

He'd make do with this for now. If he had the chance later, he'd forge a stethoscope...

Gret calmed his mind, placed one end of the blowpipe to his ear, and pressed the other end against Avril. He said he was listening to her breathing, but the end of the blowpipe slowly moved until it reached the point of strongest heart apex pulsation. He held it steady, held his breath, and listened, occasionally shifting it. The more he listened, the more serious his expression became.

There was a murmur in the apex area.

Moving to the left sternal border, the second intercostal space, the pulmonary valve area, the diastolic murmur was clearer, distinctly a continuous, mechanical-like murmur.

Moving again towards the aortic valve area, the murmur weakened. The murmur in the tricuspid valve area was also barely audible. He listened all the way around the heart and moved to below the left clavicle, where the clear, mechanical-like murmur sounded again...

A continuous, mechanical-like murmur could be heard in diastole at the second intercostal space of the left sternal border and below the left clavicle. The conduction range was extensive.

Combined with the previous intermittent cyanosis, frailty, fatigue, and seasonal cough, he highly suspected...

Patent Ductus Arteriosus.

One type of congenital heart disease. Mild cases might have no significant symptoms throughout life, while severe cases could lead to pulmonary hypertension, heart failure, and even death.

Gret shut his eyes tightly. He patiently listened to his lungs one more time, confirmed there were no abnormal breathing sounds, and put down the blowpipe. After thinking for a moment, holding onto a sliver of hope, he turned to Auntie Irene:

"Auntie, has Avril's condition... been seen by a Priest? What did the Priest say?"

His serious expression clearly startled the others. Under the oil lamp, Auntie Irene paused, forced a smile, and sent Avril to bed. Then, she let out a long sigh:

"The Bishop said Avril is just frail. She just needs to rest more and be careful not to catch a cold... To cure her completely and make her like a normal person would require Divine Arts of a very high level, which he cannot perform..."

They only thought she was frail?

Gret felt a pang of sadness, but also a sense of relief. It was good that they only knew this much. Sometimes, ignorance was a form of happiness... What could be done even if they knew it was congenital heart disease?

Heart disease had been an incurable disease for a very long time. Heart surgery, too, remained a forbidden zone in medicine for a long time after surgical practice began to develop. Theodor Billroth, an Austrian doctor revered as the "Father of Surgery" in later generations, had cast such a "curse" on heart surgery:

"Operating on the heart is a desecration of the art of surgery. Anyone who attempts heart surgery will end up ruined." (Note 1)

Without life support, without extracorporeal circulation devices, and without even the most basic methods for hemostasis, disinfection, and anesthesia, performing heart surgery under current conditions would be no different from murdering the patient.

Rather than that, it would be better to let Uncle Karen, Auntie Irene, and the others live on in their ignorance.

Gret managed to convince himself, and turned his gaze back to Avril. After her coughing stopped, the little girl's complexion had eased considerably. The faint purple on her toes had also faded, returning to a pinkish hue.

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

--Thank heavens! The cyanosis only appeared during severe coughing fits and hypoxia; it wasn't present normally!

This degree of Patent Ductus Arteriosus, developing into pulmonary hypertension, severe heart failure, and death, would take at least ten years if she was lucky!

Gret breathed a sigh of relief. He suppressed his unease and, with a smile, comforted little Avril. He chatted with Uncle Karen and Auntie Irene for a while longer before taking his leave. As the door closed behind him and vanished into the darkness, Gret shut his eyes and clenched his fist tightly.

Patent Ductus Arteriosus could be treated.

In his past life, he had seen countless patients with this condition and had referred such patients to his colleagues in cardiology.

This disease wasn't considered incurable, and treatment wouldn't even bankrupt a family.

For a child like little Avril, in his past life, all it would take was an Interventional Surgery. An Occluder would be used to close the duct between the aorta and the pulmonary artery. The entire procedure would only take an hour and a half. Her heart sounds would return to normal that same day, and she'd be bouncing around in a few days.

But that surgery was far from easy—

One needed an Electrocardiogram to determine if the heart had defects, an X-ray to rule out other illnesses, an Echocardiogram to identify the condition, and Cardiac Catheterization to understand pulmonary vascular resistance and shunt status, rule out other malformations, and confirm surgical eligibility;

One needed a Guidewire, ranging from 0.88 mm to 0.45 mm in diameter, guided by X-ray, to travel upwards along the patient's femoral artery all the way into the heart;

One needed an extremely elastic Occluder woven from Nickel-Titanium Alloy, with a high-molecular biological membrane inside, delivered by the Guidewire to the defect in the ductus arteriosus, and then controlled to open and block the gap;

Of course, one also needed a Contrast Agent of sufficient purity that wouldn't cause thrombosis when injected into the blood vessels, injected into the veins to show blood flow under X-ray and confirm the success of the surgery...

Each step, each item, was a crystallization of modern medicine and modern industry, of cutting-edge high technology. It was the result of countless years of technological, industrial, and medical development, from the Industrial Revolution to the Electrical Age and the Internet Age, that had bridged the chasm of life and turned former incurable diseases into common ailments.

But now, he, Gret Nordmark, had none of that.

This was another world.

There were no guidewires or occluders, no echocardiograms or X-rays, no anesthesia, no blood transfusions, no contrast agents...

How could he snatch little Avril's life back from the clutches of death?

Divine Arts were no longer reliable. The Bishop's statement that he couldn't treat it clearly indicated that low-level Divine Arts were ineffective against congenital diseases. Magic, magic...

Could magic emit ultrasound waves? Could magic create an electrocardiogram? Could magic summon a guidewire thin enough to enter the human heart and repair defects?

Could magic... allow him to see the mysteries within the human body?

Gret didn't know. But he knew that starting tomorrow, he would push open the door of magic. As long as he worked hard enough, as long as he had enough imagination, anything was possible!

Ten years. He would accomplish all of this within ten years!

Uncle Karen, Auntie Irene, little sister Avril--

Wait for me!

******

Notes:

Quoted from Legend Beyond the Heart

Thanks to Ye Mengbing and Mitre for the 100 Qidian coins.

Thanks to @ThisDepartureYears. for the 100 QQ coins. Sob sob sob, can you give me Qidian coins next time? You spend the same amount of money, but my income from QQ coins is cut in half, and I can't even get on the rankings...

Yesterday, there were actually 18 new favorites! 43 people cast a total of 180 recommendation votes!

Sob sob sob, you guys are too kind...

Still asking for favorites, recommendations, reviews... Whatever I can ask for, I'm asking for it all!