A 6-year-old boy with Tetralogy of Fallot presents with bluish discoloration of the lips and tongue. On examination, the structure marked B (cyanotic tongue) appears distinctly blue, and the buccal mucosa is also discolored. His hemoglobin is 16 g/dL and oxygen saturation by pulse oximetry is 88%. What is the PRIMARY pathophysiological basis for the cyanosis observed in the structure marked B?

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