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The frequency domain indices, especially the ratio of low-frequency spectral power to high-frequency spectral power, are useful for the evaluation of the cardiac autonomic function. The decreased low-frequency spectral power-to-high-frequency spectral power ratio reflects a balance of the autonomic nervous system, which shifted to parasympathetic components.

Interestingly, our case presenting with coronary AV fistula firstly reported in the literature with fetal valproate syndrome. Although differential diagnosis is sometimes difficult, it can be diagnosed with detailed history, physical examination and appropriate laboratory tests. Fetal valproate syndrome can be prevented by discontinue of the valproic acid especially during first trimester of pregnancy.

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