Though bicuspid aortic valves usually cause no adverse symptoms, difficulties may arise as the patient grows older. For example, the valve opening may become narrowed (stenotic) because of calcification of the valve leaflets. Also, the valve might not open or close completely, resulting in leakage at the valve opening (regurgitation).

Occasionally, patients with a bicuspid aortic valve will experience a progressive enlargement (dilatation) of the aorta. This can result in the formation of an ascending aorta aneurysm and, rarely, dissection (splitting open) of the aorta. Dissection is an up and down tear in the aortic wall with blood filling the inner and outer layers of the aorta.