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    ## Chapter 36: Patent Ductus Arteriosus

    “Tube?”

    Aunt Eileen looked confused. Grett gestured with his hand, mimicking the length of his forearm, then circled his thumb and forefinger together to indicate the thickness:

    “This thick, this long…and hollow…”

    “Just listen!” Aunt Eileen waved her hand generously: “Avril is so small. Besides, you’ve watched her grow up!”

    …This…Grett sweated profusely. He would never listen to a heartbeat pressed against someone’s chest again! Never, if he could help it!

    Seeing his persistence, Aunt Eileen searched in the kitchen and found a jet-black hollow tube. She cleaned it and handed it to him. Grett looked at it. The thing was longer than his entire arm, charred at one end with many burn marks—clearly a blowpipe.

    …Alright.

    He’d make do for now. He would get a stethoscope made when he had the chance…

    Grett calmed himself and placed one end of the blowpipe against his ear, the other against Avril’s chest. He said he was listening for breathing sounds, but the end of the blowpipe slowly moved until it reached the strongest point of her heart’s beating. He pressed it firmly, held his breath and listened, occasionally shifting it slightly. The more he listened, the more solemn his expression became.

    There was a murmur at the apex.

    He moved it to the pulmonary valve area, the second intercostal space at the left sternal border, and the diastolic murmur became clearer, distinctly a continuous machinery-like murmur.

    He moved to the aortic valve area, and the murmur weakened. The tricuspid valve area murmur was barely audible. He listened around the heart, then moved to the left clavicle, and the clear machinery-like murmur reappeared…

    A continuous machinery-like murmur was audible in the second intercostal space at the left sternal border and below the left clavicle during diastole. It was widely transmitted.

    Combined with the previous cyanosis that was separated, weakness, fatigue, seasonal coughing, he highly suspected…

    Patent ductus arteriosus.

    One of the classifications of congenital heart disease. In mild cases, there are no major symptoms throughout life. In severe cases, it can lead to pulmonary hypertension, heart failure, and even death.

    Grett closed his eyes tightly. He patiently listened to Avril’s lungs and confirmed that there were no breathing abnormalities before putting down the blowpipe. After a moment of thought, he turned to Aunt Eileen with a glimmer of hope:

    “Auntie, about Avril…did you ever take her to see a Pastor? What did the Pastor say?”

    His serious expression clearly frightened the others. Under the oil lamp, Aunt Eileen froze for a moment, then forced a smile and sent Avril to bed. Then, she sighed heavily:

    “The Bishop said Avril is just weak, that she should rest more and be careful not to catch a cold…If she needs to be healed to be like ordinary people, it would require a very high-level Divine Technique that he cannot perform…”

    They thought it was just weakness?

    Grett felt a little sad and a little relieved. It was good that they only knew this much. Sometimes, ignorance was bliss…What would it change even if they knew it was a congenital heart disease?

    Heart disease had been a terminal illness for a long time. Heart surgery, even after the development of surgical procedures, was a taboo in medicine for a long time. The Austrian doctor, Theodor Billroth, who was later revered as the “Father of Surgery,” had cast such a “spell” on heart surgery:

    “To operate on the heart is a desecration of surgical art. Anyone who attempts to perform heart surgery will end up disgraced.” (Note 1)

    Without life support, without extracorporeal circulation devices, or even the most basic hemostasis, disinfection, and anesthesia, attempting heart surgery under the current conditions would be tantamount to murder.

    It was better to let Uncle Kalen and Aunt Eileen remain ignorant and let things be.

    Grett managed to convince himself and turned his attention back to Avril. After the coughing subsided, the little girl’s face had recovered a lot. The faint purple on her toes had faded, returning to a pink hue.

    That pale pink was the most beautiful color in the world to Grett.

    —Thank heavens! Cyanosis only appeared during severe coughing and hypoxia, not normally!

    This level of patent ductus arteriosus, even if it developed into pulmonary hypertension, severe heart failure, and eventually death, still had more than ten years before that happened, if she was lucky!

    Grett breathed a sigh of relief. He tried to suppress his unease and smiled at Avril to comfort her. He then chatted with Uncle Kalen and Aunt Eileen for a while before leaving. The door closed behind him, and as soon as he was swallowed by the darkness, Grett closed his eyes and clenched his fists.

    Patent ductus arteriosus could be treated.

    In his previous life, he had seen countless such patients and referred many to his cardiology colleagues.

    It was not a terminal illness, and treatment did not require emptying one’s pockets.

    A child like little Avril, in his previous life, would only need an interventional surgery. A closure device would be used to seal the duct between the aorta and pulmonary artery. The whole procedure would only take an hour and a half. That day, they would be able to hear the heart sound return to normal, and a few days later, they would be able to jump around.

    But that surgery was far from easy—

    An electrocardiogram was needed to determine if the heart had defects. X-ray examination was needed to rule out other diseases. Echocardiogram was needed to identify the condition. Cardiac catheterization was needed to understand pulmonary vascular resistance, the shunting situation, rule out other malformations, and confirm whether it met the criteria for surgery;

    A guide wire, 0.88 millimeters in diameter at its thickest point and 0.45 millimeters at its thinnest, was needed to be guided by X-ray along the patient’s femoral artery all the way up to the heart;

    A closure device made of superelastic nitinol alloy, with a biocompatible polymer membrane inside, needed to be delivered to the defect in the ductus arteriosus by the guide wire, and then the closure device would be controlled to open and block the defect;

    Of course, a contrast agent with sufficient purity, which would not cause thrombosis when injected into the blood vessel, would be injected into the blood vessel, and would show the blood flow under X-ray, confirming whether the surgery was successful…

    Each one of these was the crystallization of cutting-edge high technology in modern medicine and modern industry. 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, filling in the gaps in life and turning what was once a terminal illness into the ordinary.

    But now, he, Grett Nordmark, had nothing.

    This was a different world.

    There were no guide wires, closure devices, echocardiograms, X-rays, anesthesia, blood transfusions, or contrast agents…

    How could he snatch little Avril’s life back from the hands of death?

    Divine Techniques were unreliable. The Bishop said he could not treat it, clearly lower-level Divine Techniques were unable to deal with congenital diseases. Magic, magic…

    Could magic emit ultrasound? Could magic produce an electrocardiogram? Could magic summon a sufficiently thin guide wire to enter the human heart and treat the defect?

    Could magic…let him see the secrets of the human body?

    Grett didn’t know. But he knew that he was going to open the door to magic tomorrow. As long as he worked hard enough, as long as he had enough imagination, anything was possible!

    He would achieve all this within ten years!

    Uncle Kalen, Aunt Eileen, little Avril—

    Wait for me!

    ******

    Note 1:

    Quoted from “Legends of Heart Surgery”

    Thank you to @夜梦冰 and @密特拉 for donating 100 starting currency.

    Thank you to @此去经年。 for donating 100 Q coins. Wuwuwu, can you donate starting currency next time? You spend the same amount of money, but for me, I have to take half of the Q coins, and it doesn’t even count on the ranking…

    We actually increased by 18 collections yesterday! 43 people voted a total of 180 recommendations!

    Wuwuwu, you guys are so good…

    Please continue to collect, recommend, and review…Ask for anything, I’ll ask for everything!

    (End of Chapter)

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