Saturday, March 9, 2013

Brian Cleary and BAV- A Life Saver is Saved Himself!

February 2004
Disbelief flashed through Brian Cleary's mind as he watched Richard Houchin stagger and fall. Brian was the contractor who had just had lunch with Richard and was talking with him when he suddenly collapsed that day in February 2004. 

For the tiniest fraction of a second, Brian thought Richard was joking. After all, this was Richard. Brian had known him for years and thought Richard was one of the healthiest guys around. He had been fine all through lunch. Whatever was Richard doing, kidding around like this?

No, this was not a joke. Something was terribly wrong, and Brian's finger was pressing 9-1-1 on his cell.  At that moment, neither of them knew that Richard had an aortic aneurysm tearing in his chest. And neither of them knew that as Brian made that call, there was an aneurysm in his own chest as well.

Brian Cleary (left) and Richard Houchin
September Awareness 2006, Marina del Rey, California

 Brian is "Bicuspid"!
Through the days and weeks of Richard's recovery, Brian visited him often in the hospital and then later at home. In those first foggy days after his surgery, there was so much for Richard to take in - learning that he had been born with a bicuspid aortic valve, that his aorta had enlarged silently until the day it began to tear as he stood talking to Brian, and that he had suffered a stroke. So Richard doesn't remember Brian telling him then that he too had a bicuspid aortic valve. It had been replaced years before. 

It wasn't until months later that the topic came up again, when Richard and Brian were again having lunch one day. This time, Brian gave Richard the shock of his life. He just casually brought up his own heart surgery, saying that his bicuspid aortic valve had been taken out over 10 years before. Unlike Richard, who never knew he had a bicuspid aortic valve, Brian had known about his BAV since he was about 30. When it began to fail, Brian's aortic valve was replaced with a human donor valve, a homograft.

Brian's MRI
Richard will tell you that he almost fell off his chair in the restaurant! Brian was "bicuspid" too! And then Richard became very afraid for this man sitting with him at the table - afraid because he knew that just having valve surgery doesn't take care of the aorta if you are bicuspid. Richard needed to persuade Brian to have his aorta checked. He told Brian he needed an MRI of his aorta.

You can imagine their conversations . . . talking through what is just beginning to be appreciated by physicians - that bicuspid aortic valves may be associated with abnormal tissue leading to aneurysms, especially of the ascending aorta. Brian knew that his donor valve was leaking and might need to be addressed at some point. But the idea that he might have an aneurysm too just seemed hard to believe.  Could Richard possibly be right?

If you have seen someone collapse and then fight to recover from both aortic dissection and stroke, you have a pretty good idea what you could be facing if it happens to you. You also know you might not make it at all. So Brian had an MRI, and there it was - an aneurysm. Brian's ascending aorta was bulging to just over 5 cm, roughly the same size as Richard's had been when it dissected.

Brian's Surgery - March 2005
Brian didn't hesitate scheduling his surgery, choosing a date in March 2005. This was a second surgery for Brian, what surgeons call a "redo". Brian's homograft valve was leaking and needed to come out, along with removal of his ascending aorta. Redo operations involving homografts can be complicated, but Brian's surgery and recovery went well. He emerged from surgery sporting a Dacron graft and a new bovine valve. Now it was Richard's turn to visit Brian.  

The Background
Brian Cleary and Richard Houchin have known each other a long time. Born across the world from each other, Brian in Australia and Richard in Ohio, they now know that they both began life with a bicuspid aortic valve. Later they both found their way to southern California. It's over 20 years ago since the day Richard asked an architect who he should get to work on an industrial building he was planning. He was told Brian Cleary was the one, so Richard contacted him. Richard found Brian to be a perfectionist about his work, and since then they have worked together on a number of building projects over the years. Today no one would doubt what their greatest project is. It is the project they never planned at all. It began in February 2004, a task they would never have thought to undertake - saving each other's lives.

Brian and Richard in 2006
How do you thank someone for calling 911 at the most precarious moment of your life? No doubt Richard Houchin thinks about that when he thinks about Brian Cleary.

How do you thank someone for insisting you have your chest scanned for an aneurysm when your doctors had never suggested it? Brian Cleary probably thinks about that when he thinks about Richard Houchin.

So, how do you thank someone? Well, you might take them to lunch, but if Brian and Richard do that, they joke that they might as well split the tab. Despite the fact that their most dramatic moments seem to happen around lunch time, Brian and Richard still get together often at local restaurants. And when they do, beneath their banter and laughter is an indescribable bond. Listening to them talk is like being with those who have gone through war together. There is a sense of something that only they have lived through, something only they know. They both have scars on their chests and Dacron inside, evidence of winning their fight to live.

Brian and Richard are grateful to many people who played such important parts in their experience - paramedics, their surgeon, their families.  .  .  .  But they both know that the reason they are still here begins with the two of them.

"It could be the guy standing next to you." 
For Brian and Richard, that was the case many times. When they were together, each of them was right next to someone who had an aneurysm in his chest. Neither one of them knew it.

And that is their message,  for September Awareness and for every day of the year: it is much more common than we think.

Bicuspid aortic valves are estimated to exist in up to 2% of the population, more frequently found in men than women.  Along with the bicuspid aortic valve may be abnormal aortic tissue, which can result in thoracic aortic aneurysm and dissection or rupture.

So go ahead, talk to the guy standing next to you about BAV and TAD. Sometimes, two lives may be saved.

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