What Causes Boot-Shaped Heart in the Cardiovascular System on Chest X-Ray?
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The boot-shaped heart appearance on chest X-ray is caused by Tetralogy of Fallot, a cyanotic congenital heart disease characterized by four anomalies: pulmonary stenosis (right ventricular outflow tract obstruction), ventricular septal defect, overriding aorta, and right ventricular hypertrophy. This condition leads to reduced pulmonary blood flow and right ventricular enlargement.
Why is it called so?
It is named “boot-shaped heart” or “cลur en sabot” (French for “clog-shaped heart” or “boot-shaped heart”) because the cardiac silhouette on frontal chest radiograph resembles the shape of a boot or shoe, with an elevated apex and a concave main pulmonary artery segment.
Pathophysiology
The sign develops due to right ventricular hypertrophy causing the cardiac apex to be uplifted and pointing upwards, forming the “toe” of the boot. Simultaneously, infundibular pulmonary stenosis or pulmonary trunk hypoplasia leads to a diminished, concave main pulmonary artery segment, creating the “instep” of the boot. This characteristic appearance reflects the altered cardiac anatomy and hemodynamics from the obstructed right ventricular outflow and compensatory ventricular growth.
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