A 4-month-old male infant with known tetralogy of Fallot presents with acute cyanosis, syncope, and rapid breathing during feeding. Chest X-ray shows the classic "boot-shaped" cardiac silhouette. The structure marked A in the diagram (uplifted apex) represents right ventricular hypertrophy. Which of the following best explains the pathophysiologic basis for the uplifted apex appearance on chest X-ray in this condition?

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