1. < Aortic Aneurysms

Appointment with Dr. Pochettino

Posted by sbest010 @sbest010, May 27 9:37am

Please advise if anyone has experience with scheduling a second opinion with Dr. Pochettino. I am looking to see if he/his team will do a record reviews or a second opinion consult via Zoom.

I am willing to pay for this independently but since I live out of state, I was seeking guidance.

If this is not possible, please advise if anyone can offer guidance on how best to obtain an in person appointment.

For background, I was recently diagnosed in April 2024 of a 4.2 dilation of my ascending aorta via a CT scan which was an incidental finding when additional screening related to a mammogram finding was being performed.

I am aware that normally this would not meet the surgical threshold but I am presenting with difficulty swallowing at times and intermittent hoarseness. In addition my stature is small at 5ft which I understand should be considered as part of the equation.

Any help or guidance would be greatly appreciated. Thank you

Interested in more discussions like this? Go to the Aortic Aneurysms Support Group.

fjc1962 | @fjc1962 | May 28 8:51am
In reply to @jeanern01 "I did an in person consult with Dr.Pochettino. Him and his team were awesome. They did..." + (show)
@jeanern01

I did an in person consult with Dr.Pochettino. Him and his team were awesome. They did a great job replacing part of my aortic arch and left subclavian in 2019, and I am doing great! Would highly recommend him and Mayo for a consult. I flew there from Florida for my surgery and would not hesitate to do it again. I also had Dr.Bower do a vascular surgery at the same time- he was great as well.
Best wishes
Jeane

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Very helpful as I am also in Florida and was considering traveling to Rochester for surgery. I am currently at 4.9 and a patient at Mayo in Jacksonville. Did you have any issues with the distance and travel afterwards?

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chrisn61 | @chrisn61 | May 28 8:59am

Mayo is awesome! But... it can be hard to get an appointment. If you can't get one, google Cleveland Clinic 2nd Opinion. It looks like they have much broader access. Though I don't believe it will be covered by insurance.

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ginnycake | @ginnycake | May 28 2:16pm
In reply to @moonboy "I had a Type A-1 complete dissection in 2015 repaired by emergency surgery at UCSD. The..." + (show)
@moonboy

I had a Type A-1 complete dissection in 2015 repaired by emergency surgery at UCSD. The difficulty swallowing and hoarseness likely come from the fact that your aorta is enlarged and pressing up against your esophagus. I had serious difficulty swallowing before (and still after) my dissection. Think of it like this overly simplistic analogy: an aortic aneurysm is like a water balloon inside of your chest, slowly stretching, and getting bigger over time. If it breaks, you're in big trouble. In 2021, I saw 8K High-Def CT Scan Images in 3D at the University of Minnesota during my semi-annual scans after surgery. The U of M imaging center at Fulton Street in Minneapolis is FANTASTIC for follow up annual surveillance scans. I literally could see my aorta pressed against my esophagus. Following two open heart surgeries (one to repair and one to close me up and check for leaks three days later) I had to have throat surgery to repair my vocal cords. So, I think that it's smart to get a second opinions--especially if you're having trouble swallowing. Unless this has happened to you, and you happen to be a thoracic surgeon, it's hard for doctors to sometimes grasp the little things that precede a dissection. There were huge red flags in my life that I did not see until after it dissection (trouble swallowing was a big one). I would strongly recommend a second opinion at Mayo, Cleveland Clinic, and my favorite UCSD-San Diego. Find a thoracic surgeon that has done lots of these and has been around for 30 years. You're right to be concerned and right to get a second. You're going to be fine.

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Question… When you say trouble swallowing, do you mean that you literally can’t make your muscles constrict to swallow or do you mean that something gets stuck in your chest after you swallow I’m having trouble sometimes actually feeling like I can’t get the actual apparatus to work( my swallowing muscles). I have an ascending aortic aneurysm diagnosed last year that hasn’t expanded as far as I know. my last CT was in April and it ranges (depending on whether it’s a CT or an echocardiogram) between 4.0 and 4.2 recently measured 4.0 and since I know they don’t shrink or least, that’s what I understand, then it must’ve been the angle that they measured it. I’m really interested in a more detailed description of what you mean by difficulty swallowing

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sbest010 | @sbest010 | May 28 2:38pm

Regarding the difficulty swallowing, my trouble lays in when the food enters the esophagus and results in feeling something is stuck.

There are three phases of swallowing that occur beginning with food entering the mouth and the final phase of it leaving the esophagus into the stomach.

Often I have to drink a cup or two of warm water to relax the esophagus and allow food to enter the stomach.

I suspect this is from the pressure of the aneurysm on the mediastinum which houses the esophagus.

If you have had imaging see if they comment on the mediastinum and whether it has shifted.

Hope things turn out well. I understand the fear and uncertainty.

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crhp194 | @crhp194 | May 28 5:17pm
In reply to @sbest010 "Thank you for your response. I am seeking an appointment with him based on my research..." + (show)
@sbest010

Thank you for your response. I am seeking an appointment with him based on my research but I was wondering if he ever did virtual appointments and how difficult it is to obtain an appointment. Some of the physicians have a waiting list up to a year.

I understand the aneurysm tend to be slow growing but I have presenting symptoms of difficulty swallowing and intermittent hoarseness so I know the aneurysm is pressuring on the nerve to the larynx so the sooner the appointment the better.

I am so grateful for these forums and the people that take the time to respond.

The discovery came as an incidental finding so I am trying to educate myself the best I can. Thank you

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Wish I could answer your questions but my surgery was scheduled so quickly, I never had time to think about it. Talked with Dr Pochettino while at Mayo along with Dr Oderich. Think you should start trying now to get an appointment. Mayo will want CT scans plus lots of other health measures. Aneurysms can burst and that’s serious, if not life threatening. Good luck to you!

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1 reply
sbest010 | @sbest010 | May 28 5:54pm
In reply to @crhp194 "Wish I could answer your questions but my surgery was scheduled so quickly, I never had..." + (show)
@crhp194

Wish I could answer your questions but my surgery was scheduled so quickly, I never had time to think about it. Talked with Dr Pochettino while at Mayo along with Dr Oderich. Think you should start trying now to get an appointment. Mayo will want CT scans plus lots of other health measures. Aneurysms can burst and that’s serious, if not life threatening. Good luck to you!

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Thank you for your advice.

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1 reply
bitsygirl | @bitsygirl | May 30 7:01pm
In reply to @sbest010 "Thank you for your advice." + (show)
@sbest010

Thank you for your advice.

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You indicated that you are trying to learn more. You might be interested to read the information at this link: https://www.ahajournals.org/doi/10.1161/CIR.0000000000001106 and the information here: https://consultqd.clevelandclinic.org/thoracic-aortic-aneurysm-how-to-counsel-when-to-refer. These are links to information for doctors, but I have found them useful to try to educate myself before meeting with my doctor.

There’s an app you can input your relevant information in and it will let you know the recommendations from various organizations regarding surgery. It’s called “Aortic Surgery Guidelines”. It doesn’t seem to include symptoms and, as you note, that should change the “equation”.

Good luck!

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2 replies
sbest010 | @sbest010 | May 31 2:49am
In reply to @bitsygirl "You indicated that you are trying to learn more. You might be interested to read the..." + (show)
@bitsygirl

You indicated that you are trying to learn more. You might be interested to read the information at this link: https://www.ahajournals.org/doi/10.1161/CIR.0000000000001106 and the information here: https://consultqd.clevelandclinic.org/thoracic-aortic-aneurysm-how-to-counsel-when-to-refer. These are links to information for doctors, but I have found them useful to try to educate myself before meeting with my doctor.

There’s an app you can input your relevant information in and it will let you know the recommendations from various organizations regarding surgery. It’s called “Aortic Surgery Guidelines”. It doesn’t seem to include symptoms and, as you note, that should change the “equation”.

Good luck!

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Bitsygirl thank you so much for the very informative articles. The links provided contained exactly the type of information I was seeking.

I believe in being as educated as possible on the subject matter.

Thank you for taking the time to share the research. It is most appreciated.

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upartist | @upartist | Jun 1 6:40am
In reply to @bitsygirl "You indicated that you are trying to learn more. You might be interested to read the..." + (show)
@bitsygirl

You indicated that you are trying to learn more. You might be interested to read the information at this link: https://www.ahajournals.org/doi/10.1161/CIR.0000000000001106 and the information here: https://consultqd.clevelandclinic.org/thoracic-aortic-aneurysm-how-to-counsel-when-to-refer. These are links to information for doctors, but I have found them useful to try to educate myself before meeting with my doctor.

There’s an app you can input your relevant information in and it will let you know the recommendations from various organizations regarding surgery. It’s called “Aortic Surgery Guidelines”. It doesn’t seem to include symptoms and, as you note, that should change the “equation”.

Good luck!

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Thank you Bitsy Girl! Very helpful!!!

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hsminc | @hsminc | Jun 2 11:58am

Dr. Pochettino is fabulous. We sought a second opinion with him and decided to stay with him until and if aneurysm surgery is necessary.
He is not only a kind and smart man but we were very interested in his research on antegrade cerebral perfusion, which keeps blood flowing to the brain during open heart surgery - which, of course, is what an aneurysm involves.
While a previous surgeon had said that he would just work quickly to get the repair done within the requisite 20 minutes cooling time, we were interested in someone that would and could use other methods. What if the surgery could not be done within 20 minutes? We were very concerned about cognitive deficits resulting from surgery.
I work with patients anticipating surgery. There is growing realization, especially for older patients, that general anesthesia, anesthesia overall, and just the surgical process produces inflammation. UCSF researchers recently published work stating they may have identified a brain element that produces the immune reaction that possibly is responsible for damage in the brain stemming from surgery. This was denied for years but more and more research indicates that this is something to be concerned about.
Usually you must schedule at least three months ahead of time to see almost any physician at Mayo. Mayo may not have relationships with all insurers and it may be difficult to schedule if you have some Medicare Advantage products; this is true for many, if not most, big medical centers. You need to talk to the insurance people.

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