What cardiac condition is associated with a boot-shaped heart appearance?

The appearance of a boot-shaped heart on imaging is primarily associated with Tetralogy of Fallot. This characteristic shape arises due to specific anatomical features of the heart related to this congenital condition. In Tetralogy of Fallot, there is a combination of four defects: ventricular septal defect (VSD), pulmonary stenosis, an overriding aorta, and right ventricular hypertrophy.

The boot shape is pronounced because of the right ventricular hypertrophy that occurs due to increased pressure in the right ventricle from the pulmonary stenosis. Furthermore, the positioning and size of the heart on imaging create this distinctive silhouette.

In contrast, the other conditions listed do not typically present with a boot-shaped heart. Transposition of the Great Arteries usually results in a more rounded heart with different contours. Ebstein's Anomaly can lead to various heart shapes but is not typically associated with the boot shape. Pericardial effusion results in an enlarged heart silhouette but is often globular rather than shaped like a boot. Therefore, the unique combination of cardiac anomalies in Tetralogy of Fallot leads to the recognizable boot-shaped appearance on chest X-rays or echocardiograms.