Reduced combined ventricular output and increased oxygen extraction fraction in a fetus with complete heart block demonstrated by MRI Meng Yuan Zhu,

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Reduced combined ventricular output and increased oxygen extraction fraction in a fetus with complete heart block demonstrated by MRI Meng Yuan Zhu, MS, Edgar Jaeggi, MD, Christopher W. Roy, MSc, Christopher K. Macgowan, PhD, Mike Seed, MBBS HeartRhythm Case Reports Volume 2, Issue 2, Pages 164-168 (March 2016) DOI: 10.1016/j.hrcr.2015.12.010 Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 1 A: M mode at 36 weeks gestation demonstrates a slow ventricular rate and complete dissociation between atrial and ventricular contraction. V = ventricular; A = atrial. B: Fetal descending aortic flow curve measured by phase-contrast magnetic resonance with metric optimized gating at 35 weeks gestation. Fetal cardiac cycle was 1157 ms, corresponding to heart rate 52 beats per minute. HeartRhythm Case Reports 2016 2, 164-168DOI: (10.1016/j.hrcr.2015.12.010) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 2 Ultrasound-estimated fetal weight plotted on a reference male singleton weight chart. The fetal weight percentile dropped from 26 weeks to 36 weeks. (23 wk: 35th; 26 wk: 45th; 29 wk: 15th; 33 wk: 10th; 35 wk: 3rd; 36 wk: 2nd).18 HeartRhythm Case Reports 2016 2, 164-168DOI: (10.1016/j.hrcr.2015.12.010) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 3 A: Magnetic resonance imaging measured flow in major fetal vessels. B: Oxygen saturation calculated based on T2 relaxation time in major fetal vessels. C: Calculated oxygen consumption (VO2), oxygen delivery (DO2), and oxygen extraction fraction (OEF). Reference ranges for each parameter for normal fetuses are also shown.5,7 CVO = combined ventricular output; MPA = main pulmonary artery; AAo = ascending aorta; SVC = superior vena cava; DA = ductus arteriosus; DAo = descending aorta; PBF = pulmonary blood flow; UV = umbilical vein. HeartRhythm Case Reports 2016 2, 164-168DOI: (10.1016/j.hrcr.2015.12.010) Copyright © 2016 Heart Rhythm Society Terms and Conditions