Preservation of the pulmonary valve, even at the expense of a mild residual stenosis, is the current surgical policy for the management of patients with tetralogy of Fallot (TOF). This study aimed to assess the long-term effect of a residual right ventricular outflow tract obstruction (RVOTO) on RV dimension and function. This study prospectively assessed 53 children (mean age, 13.4 ± 6.4 years) after repair of TOF using cardiovascular magnetic resonance imaging. Residual RVOTO on echocardiography was defined as a peak systolic RVOT gradient of 25 mmHg or higher. Patients with RVOTO (n = 29) had significantly less pulmonary regurgitation (25.2 ± 10.6 %) than patients without RVOTO (30.8 ± 9.3 %; p = 0.05) (n = 24). Compared with patients who had no RVOTO, children with RVOTO had significantly smaller RV end-diastolic volume (94.0 ± 2.6 vs 104.0 ± 20.7 ml/m²; p < 0.05) and end-systolic volume (42.9 ± 20.0 vs 48.9 ± 13.2 ml/m²; p < 0.05), whereas RV ejection fraction did not differ significantly between the two groups (55.5 ± 8.4 vs 54.0 ± 6.6 %). Restrictive physiology, assessed by late diastolic forward flow in the main pulmonary artery, was equally distributed within the two groups (31 vs 25 %; nonsignificant difference). According to the study data, residual RVOTO after repair of TOF does not affect RV function, whereas RV dimensions and the degree of pulmonary regurgitation are more favorable in the long-term follow-up evaluation of those patients. These results confirm the beneficial effects of the current strategy for repair of TOF.