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Transcript of … could their antioxidant and antiinflammatory components interfere with prostaglandin metabolism...
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… could their antioxidant and antiinflammatory components interfere with prostaglandin metabolism and thus influence
fetal ductus arteriosus dynamics?
![Page 2: … could their antioxidant and antiinflammatory components interfere with prostaglandin metabolism and thus influence fetal ductus arteriosus dynamics?](https://reader036.fdocuments.us/reader036/viewer/2022062517/56649edf5503460f94befd7a/html5/thumbnails/2.jpg)
ORIENTATION TO WITHDRAWL FOODS WITH MORE OF 30mg/100g
COMPLETE REVERSION IN 96.3% (48/52 FETUSES WITH DUCTAL CONSTRICTION)
(3 WEEKS AFTER SUSPENSION OF THE SUBSTANCES)
FOOD FREQUENCY QUESTIONNAIRE FOR QUANTIFICATION OF DAILY INGESTION OF
POLIPHENOLS
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PRE POST
1.70 ± 0.41
2.19 ± 0.43
P=0.001
Pulsatility Index
CONSTRICTION OF DUCTUS ARTERIOSUS
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Polyphenols
FLAVONOLS
FLAVONS
FLAVONONS
FLAVAN - 3 - ONS
ANTOCYANIDINS
FLAVONOIDS
Catequinas
Epicatequinas
Teaflavinas
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ANTIINFLAMMATORY AND ANTIOXIDANT EFFECTS OF COMMON FOODS
GREEN TEA
BLACK TEA
MATE TEA
ORANGE JUICE
DARK CHOCOLATE
RESVERATROL
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• HERBAL TEAS AND OTHER FLAVONOID-RICH FOODS
[3-gallate-gallocatechin, quercitin, cacao,…]
• GRAPE DERIVATIVES
[resveratrol]
POLYPHENOLS WITH ANTIINFLAMMATORY ACTIONS DEPENDENT ON INHIBITION OF COX-2 AND PROSTAGLANDINS
FETAL DUCTAL CONSTRICTION ?
3rd TRIMESTER MATERNAL INGESTION
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CONSTRICTION OF DUCTUS ARTERIOSUS
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IN NORMAL FETUSES, DUCTAL FLOW DYNAMICS AND RIGHT
VENTRICULAR SIZE ARE INFLUENCED BY MATERNAL CONSUMPTION
OF POLYPHENOL-RICH FOODS (CASE-CONTROL STUDY)
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1509.05 mg/day (>perc 75)
Daily consumption of polyphenols
0
1000
2000
AT DIAGNOSIS
80.05 mg/day (<perc 25)
P= 0.0001
AFTER ORIENTATION
GA=32 ± 2 wks
(28 - 38 wks)
CONSTRICTION OF DUCTUS ARTERIOSUS
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SYST VEL
DIAST VEL
PI
DOPPLER BEFORE AND AFTER
INGESTION OF GREEN TEA
(CASES)
p < 0.001
p =0.003
p < 0.001
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VE
VD
Heart specimen of a fetal lamb
exposed to green tea
RV HYPERTROPHIC AND DILATED RV/LV RATIO
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DUCTAL HISTOLOGY IN FETAL LAMB EXPOSED TO GREEN TEA
DECREASED DUCTAL LUMEN AND INCREASED
MEDIAL AVASCULAR ZONE THICKNESS
DUCTAL LUMEN
687.7 um
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238.4
933.3
AVASCULAR ZONE
Control
AVASCULAR ZONE
Case
DUCTAL HISTOLOGY
746.6 ± 214.6
255.3 ± 97.9
p < 0.001
MEAN CONTROLS
THICKNESS:
MEAN CASES
THICKNESS:
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OBJECTIVE
To investigate the interrelationships between fetal ductal flow dynamics, oxidative damage and polyphenol excretion after experimental exposure of PRF in sheep during late pregnancy
15
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BASAL 14 DAYS
Control PRFControl PRF
N=5 N=10N= 2 N= 7
Statistics: Generalized Estimating Equations, post hoc Bonferroni.
SUFFOLK SHEEP (90-100kg) >120 DAYS GESTATION
STUDY SETUP
Habitual diet (basic
polyphenol ingestion)
PRF supplementation (basic ingestion +
3100 mg/day
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OPEN CLINICAL TRIAL
2 weeks1st ECHO
SUSPENSION OF
POLYPHENOL_RICH FOODS
Nutritional Questionnaire
Nutritional Questionnaire
2nd ECHO 3rd ECHO2 weeks
n = 72 FETUSES GA > 28 WEEKS
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1509.05 mg/day (>perc 75)
Daily consumption of polyphenols
0
1000
2000
AT DIAGNOSIS
80.05 mg/day (<perc 25)
P= 0.0001
AFTER ORIENTATION
GA=32 ± 2 wks
(28 - 38 wks)
CONSTRICTION OF DUCTUS ARTERIOSUS
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CONCLUSION OF INTERVENTIONAL STUDY
The oriented restriction of maternal ingestion of
polyphenol-rich foods in the third trimester is
followed by regression of fetal ductal constriction.
CONSTRICTION OF DUCTUS ARTERIOSUS
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IN NORMAL FETUSES, DUCTAL FLOW DYNAMICS AND RIGHT
VENTRICULAR SIZE ARE INFLUENCED BY MATERNAL CONSUMPTION
OF POLYPHENOL-RICH FOODS (CASE-CONTROL STUDY)
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143 NORMAL FETUSES FROM NORMAL MOTHERS IN THE THIRD SEMESTER OF PREGNANCY
102 FETUSES WITH MATERNAL
INGESTION OF POLIPHENOLS
(> 75th PERCENTILE,
1089 MG)
41 FETUSES WITHOUT MATERNAL INGESTION OF POLIPHENOLS (< 25th PERCENTILE,
127 MG)
28.4 ± 3.1 wks (23-38 wks)
FETAL DOPPLER ECHOCARDIOGRAM
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>PERC 75 <PERC 25PERC 75
SYST VEL DIAST VEL
RV/LV RATIO
P<0.001 P=0.011
P<0.001
FETAL DUCTAL FLOW VELOCITIES AND RV/LV RATIO ACCORDING TO MATERNAL POLYPHENOL CONSUMPTION
0.96
0.96
0.960.17
1.23
0.61 0.11
0.94
>PERC 75 <PERC 25
>PERC 75 <PERC 25
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Fetal ductal constriction detection in fetal CHD
Consider the possibility of mild ductal constriction in any fetal left heart disease (HLHS) with a decreasing CV Profile score (TR, decreasing RV function)
Counsel mothers on polyphenol foods early after fetal diagnosis
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Use of Maternal Indomethacin and Fetal Ductal Constriction
• Indomethacin doses of 25 mg PO BID or TID are effective for tocolysis
• Short course of 48 hours is well tolerated • Some types of ductal dependent CHD
can have short-course indomethacin tocolysis safely i.e. pulmonary atresia, Tetralogy of Fallot, etc.
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Effects of Indomethacin ductal closure in R heart disease e.g. Ebstein and TV dysplasia
• Constriction/occlusion of the ductus arteriosus• Theoretical constriction of coronary arteries• Increase in pulmonary vascular resistance
Benefits• Prevent or reverse pulmonary valve regurgitation• Decrease tricuspid valve regurgitation • Promote systolic pulmonary arterial flow• Improve systemic flow
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Approach to the fetus with CHDand preterm labor
• Early identification• Address the cause (i.e. infection, indocin for
poly) • Aggressive management of cervical
incompetence, Redefine “viability”• Screen for CHF• Consider tocolysis early
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Advances in Perinatal Cardiology 10th Fun in the Sun Course
Focus: Fetal Cardiac Treatment
Arrhythmia ManagementSee www.allkids.org
“Conferences”
Oct.23-26, 2014St. Petersburg, FL