Boot-shaped heart on chest X-ray is indicative of which condition?

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Boot-shaped heart on a chest X-ray reflects prominent right ventricular hypertrophy with relatively reduced pulmonary vasculature, producing a silhouette that looks like a boot. This pattern is classic for Tetralogy of Fallot, a cyanotic congenital defect where subpulmonic (infundibular) stenosis causes outflow obstruction to the lungs, leading to RV hypertrophy and a decreased pulmonary blood flow. The four components—pulmonary stenosis, right ventricular hypertrophy, an overriding aorta, and a ventricular septal defect—together explain both the silhouette and the clinical cyanosis. Other congenital lesions have different radiographic patterns, such as an “egg-on-a-string” appearance with transposition of the great arteries, or increased pulmonary markings with truncus arteriosus, so the boot shape is most characteristic of Tetralogy of Fallot.