Chapter 36

"Tube?"

Aunt Ailin was doubtful. Great reached out and gestured the length of his forearm, then formed a circle with his left thumb and index finger to measure the thickness:

"So thick, so long... it needs to be hollow..."

"Just listen directly!" Aunt Ailin waved her hand grandly: "Avril is so small. Besides, you've watched her grow up!"

This... Great broke out in a sweat. He never wanted to listen to heart sounds by pressing against someone's chest again! Not if he had a choice!

Seeing his determined effort, Aunt Ailin searched in the kitchen and found a black hollow tube, which she cleaned and handed over. Great examined it in his hand; the thing was longer than his entire arm, one end covered in soot, with many burn marks, clearly a blowpipe.

...Alright.

Let's make do for now. If there's a chance later, I'll make a stethoscope...

Great calmed his mind, placed one end of the blowpipe to his ear, and the other against Avril's body. He said he was listening to the breathing sounds, but the end of the blowpipe slowly moved until it reached the point of strongest heart apex beat. He firmly pressed it, held his breath, and listened, occasionally moving it, his expression growing increasingly serious.

There was a murmur at the heart apex.

Moving to the pulmonary valve area on the left sternal border, at the second intercostal space, the diastolic murmur became clearer, distinctly a continuous mechanical murmur.

Moving to the aortic valve area, the murmur gradually weakened. The murmur in the tricuspid valve area was almost inaudible. After listening around the heart, he moved to the left subclavicular area, where the clear mechanical murmur sounded again...

At the left sternal border, second intercostal space, and left subclavicular area, a continuous mechanical diastolic murmur can be heard. The conduction range is extensive.

Combining this with the previous cyanosis, weakness, fatigue, and seasonal cough, it is highly suspected...

Patent ductus arteriosus.

One of the types of congenital heart disease. Mild cases may have no significant symptoms throughout life, while severe cases can lead to pulmonary hypertension, heart failure, and even death.

Great closed his eyes tightly. He patiently listened to the lungs, confirming that the breathing sounds were normal, and put down the blowpipe. After some thought, he turned to Aunt Ailin with a glimmer of hope:

"Aunt, has anyone seen a priest about Avril's condition? What did the priest say?"

His serious expression clearly frightened the others. Under the oil lamp, Aunt Ailin was taken aback, forced a smile, and sent Avril to bed. Then, she sighed deeply:

"The bishop said that Avril is just weak and needs to rest more and be careful not to catch a cold... If she needs to be treated to be like a normal person, it would require a very high-level divine spell, which he cannot perform..."

Do they just think she's weak?

Great felt a bit sad but also a bit relieved. It's better if they only know this much. Sometimes, ignorance is a kind of happiness... Knowing it's a congenital heart disease, what can be done?

Heart disease was a terminal illness for a long time. Heart surgery was a medical taboo for a long time after the development of surgical techniques. The Austrian doctor Theodor Billroth, revered as the "father of surgery," once cast a "curse" on heart surgery:

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

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

Rather than that, it might be better to let Uncle Karen, Aunt Ailin, and the others live in ignorance.

Great barely convinced himself and turned his gaze back to Avril. After the coughing stopped, the little girl's face had improved a lot. The light purple on her toes had faded, turning back to pink.

This light pink was, to Great, the most beautiful color in the world.

—Thank goodness! The cyanosis only appears during severe coughing and oxygen deprivation, not normally!

At this level of patent ductus arteriosus, it could take over ten years to develop into pulmonary hypertension, severe heart failure, and death, if she's lucky!

Great breathed a sigh of relief. He tried to suppress his unease, smiled reassuringly at little Avril, chatted a bit more with Uncle Karen and Aunt Ailin, and then bid them farewell. As the door closed behind him, Great closed his eyes and clenched his fists tightly.

Patent ductus arteriosus can be treated.

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

This disease is not a death sentence, and treatment doesn't have to bankrupt a family.

For a child like little Avril, if it were in his previous life, only an interventional procedure would be needed. Using a closure device to block the ductus between the aorta and pulmonary artery, the entire surgery would take only an hour and a half. The heart sounds would return to normal on the same day, and she would be back to her lively self in a few days.

But how easy is that surgery—

An electrocardiogram to determine if there are any heart defects, X-rays to rule out other conditions, echocardiography to identify the disease, and cardiac catheterization to assess pulmonary vascular resistance and shunt conditions, rule out other malformations, and confirm if the patient meets the surgical criteria;

A guidewire, with a diameter ranging from 0.45 to 0.88 millimeters, guided by X-rays, traveling up the patient's femoral artery to the heart;

A highly elastic nickel-titanium alloy closure device, with a high-molecular biological film, delivered to the defect in the ductus and controlled to open and block the gap;

Of course, a high-purity contrast agent, which won't cause thrombosis when injected into the blood vessels, to show the blood flow under X-rays and confirm the success of the surgery...

Each of these is a product of modern medicine and modern industry, the pinnacle of high technology. It took years of technological, industrial, and medical development from the Industrial Revolution to the Electrical and Internet Ages to bridge the gap in life, turning once-terminal illnesses into common ones.

But now, he, Great Nordmark, has nothing.

This is a different world.

No catheters, guidewires, closure devices, echocardiography, X-rays, anesthesia, blood transfusions, or contrast agents...

How can he snatch a life from the hands of death?

Divine spells are no longer reliable. The bishop said he couldn't treat it, clearly indicating that lower-level divine spells can't handle congenital diseases. Magic, magic...

Can magic produce ultrasound? Can magic create an electrocardiogram? Can magic summon a fine guidewire to enter the human heart and treat the defect?

Can magic let him see the mysteries inside the human body?

Great doesn't know. But he knows that from tomorrow, he will open the door to magic. As long as he works hard and has enough imagination, anything is possible!

In ten years, he will achieve all this!

Uncle Karen, Aunt Ailin, little Avril—

Wait for me!

******

Note 1:

Quoted from "The Legend of Cardiac Surgery"