A chest X-ray of a 6-year-old cyanotic child shows a BOOT-shaped heart with decreased pulmonary vascular markings. Which congenital heart disease is most likely?

Correct option is B

BOOT-shaped heart with pulmonary oligemia is characteristic of Tetralogy of Fallot due to right ventricular hypertrophy and upturned apex.
Explanation of options: (a) ✘ VSD causes cardiomegaly and pulmonary plethora, not boot shape. (b) ✔ Correct; TOF shows classic boot shape + decreased lung markings. (c) ✘ TGA shows “egg on a string” appearance, not boot shape. (d) ✘ Tricuspid atresia → decreased pulmonary flow but different X-ray features.