A 4-month-old male infant presents with recurrent cyanotic spells triggered by feeding and crying. On examination, he has central cyanosis, clubbing, a single S2, and a harsh systolic ejection murmur at the left upper sternal border. Chest radiograph shows a boot-shaped heart with decreased pulmonary vascularity. Echocardiography confirms tetralogy of Fallot with all four anatomic lesions. The structure marked **D** (RV hypertrophy) in the diagram develops as a secondary consequence of which primary pathophysiologic mechanism?
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