{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T09:04:47Z","timestamp":1789722287710,"version":"4.0.1"},"reference-count":20,"publisher":"Walter de Gruyter GmbH","license":[{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"j_jpm-2026-0392_abs_001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Graphicflow is a commercially available ultrasound technology that uses trajectory-based blood speckle tracking to display intracardiac blood-cell movement in real time during fetal echocardiography. Unlike conventional Doppler ultrasound, which mainly measures blood-flow velocity and direction, this technique offers an additional perspective by revealing how blood moves, circulates, and organizes within the fetal heart. Although interest in this approach has grown over recent years, the current evidence remains limited and is largely based on early feasibility studies and small observational reports.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_jpm-2026-0392_abs_002\">\n                    <jats:title>Content<\/jats:title>\n                    <jats:p>This illustrated Opinion Paper brings together the available evidence on trajectory-based fetal hemodynamic imaging by reviewing published fetal, neonatal, and pediatric blood speckle-tracking studies alongside international fetal echocardiography guidelines, technical reports, and established principles of cardiovascular fluid dynamics. We discuss the underlying physics of blood speckle tracking, the physiological significance of intracardiac flow patterns, potential clinical applications, existing technical challenges, and key considerations for responsible clinical adoption. We also include original fetal imaging examples and conceptual illustrations to summarize current knowledge while highlighting important gaps that require further investigation. Given the limited clinical validation currently available, this review should be viewed as an evidence-informed synthesis and a framework for generating future research hypotheses rather than evidence supporting routine clinical\u00a0use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_jpm-2026-0392_abs_003\">\n                    <jats:title>Summary<\/jats:title>\n                    <jats:p>Current evidence suggests that trajectory-based blood-flow imaging may complement conventional fetal echocardiography by providing qualitative visualization of intracardiac flow organization beyond velocity mapping alone. However, standardized acquisition protocols, quantitative hemodynamic metrics, reproducibility, gestational age-specific normative datasets, and prospective multicenter validation remain necessary before routine clinical implementation can be recommended.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_jpm-2026-0392_abs_004\">\n                    <jats:title>Outlook<\/jats:title>\n                    <jats:p>Future research should prioritize methodological standardization, rigorous clinical validation, and demonstration of incremental clinical value beyond conventional fetal echocardiography to support the responsible integration of trajectory-based fetal hemodynamic imaging into clinical practice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1515\/jpm-2026-0392","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T08:56:57Z","timestamp":1789721817000},"source":"Crossref","is-referenced-by-count":0,"title":["Graphicflow ultrasound in fetal echocardiography: principles, hemodynamics, clinical applications, and future perspectives"],"prefix":"10.1515","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9062-8501","authenticated-orcid":false,"given":"Wiku","family":"Andonotopo","sequence":"first","affiliation":[{"name":"Fetomaternal Division, Women Health Center, Department of Obstetrics and Gynecology , Ekahospital BSD City , Tangerang , Indonesia"},{"name":"Faculty of Medicine , Maranatha Christian University , Bandung , Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1710-3909","authenticated-orcid":false,"given":"Muhammad Adrianes","family":"Bachnas","sequence":"additional","affiliation":[{"name":"Fetomaternal Division, Department of Obstetrics and Gynecology , Medical Faculty of Sebelas Maret University, Dr. Moewardi Hospital , Surakarta , Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mochammad Besari","family":"Adi Pramono","sequence":"additional","affiliation":[{"name":"Fetomaternal Division, Department of Obstetrics and Gynecology , Medical Faculty of Diponegoro University, Dr. Kariadi Hospital , Semarang , Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julian","family":"Dewantiningrum","sequence":"additional","affiliation":[{"name":"Fetomaternal Division, Department of Obstetrics and Gynecology , Medical Faculty of Diponegoro University, Dr. Kariadi Hospital , Semarang , Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aloysius","family":"Suryawan","sequence":"additional","affiliation":[{"name":"Fetomaternal Division, Department of Obstetrics and Gynecology, Faculty of Medicine , Maranatha Christian University , Bandung , Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ridwan Abdullah","family":"Putra","sequence":"additional","affiliation":[{"name":"Fetomaternal Division, Department of Obstetrics and Gynecology, Faculty of Medicine , Maranatha Christian University , Bandung , Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I Nyoman","family":"Hariyasa Sanjaya","sequence":"additional","affiliation":[{"name":"Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology, Faculty of Medicine , Udayana University, Prof. Dr. I.G.N.G Ngoerah General Hospital , Bali , Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dudy","family":"Aldiansyah","sequence":"additional","affiliation":[{"name":"Fetomaternal Division, Department of Obstetrics and Gynecology, Faculty of Medicine , Sumatera Utara University, H. Adam Malik General Hospital , Medan , Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Efendi","family":"Lukas","sequence":"additional","affiliation":[{"name":"Fetomaternal Division, Department of Obstetrics and Gynecology, Faculty of Medicine , Hassanudin University, Wahidin Sudirohusodo Hospital , Makassar , Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nuswil","family":"Bernolian","sequence":"additional","affiliation":[{"name":"Fetomaternal Division, Department of Obstetrics and Gynecology, Faculty of Medicine , Sriwijaya University, Mohammad Hoesin Hospital , Palembang , Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adhi","family":"Pribadi","sequence":"additional","affiliation":[{"name":"Fetomaternal Division, Department of Obstetrics and Gynecology, Faculty of Medicine , Padjadjaran University, Hasan Sadikin Hospital , Bandung , Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2181-3442","authenticated-orcid":false,"given":"Waskita Ekamaheswara","family":"Kasumba Andanaputra","sequence":"additional","affiliation":[{"name":"Department of Medicine, Undergraduate Program in Medical Science, Faculty of Medicine , Padjadjaran University , Bandung , Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2026,9,18]]},"reference":[{"key":"2026091808564788430_j_jpm-2026-0392_ref_001","unstructured":"GE HealthCare. 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