Consider the following medical report that includes the patient's historical health records. Use it to predict the disease that the patient is high likely exposed to. 

 Medical Report: allergies: penicillins attending: chief complaint: bioprosthetic aortic stenosis major surgical or invasive procedure: - redo sternotomy, aortic valve replacement (23mm st. regent mechanical) history of present illness: this 71 year old gentleman has a history of an avr(#23 mm bovine pericardial valve/radiofrequency maze ablation of pulmonary veins)done . recently, he has been experiencing progressive stenosis of his aortic valve prosthesis. his most recent echo done on demonstrated a peak gradient of 175mmhg and a mean gradient of 100mmhg. symptomatically he has mild dyspnea with exertion for the past 2 months, but no chest pain or lightheadedness.he denies pnd, orthopnea, lightheadedness, edema or claudication. cardiac cath did not show significant coronary disease. his surgery has been delayed due to need for ongoing diuresis as an out patient. he is admitted today for cxr and posssible further diuresis and surgery tomorrow. past medical history: s/p bovine avr/maze procedure atrial fibrillation obstructive sleep apnea on cpap gout gastroesophageal reflux noninsulin dependent diabetes mellitus cholelithiasis left lower lobe nodule s/p left knee surgery s/p exploratory laparotomy and removal of foreign body s/p bilateral hernia repair s/p basal cell skin cancer removal social history: smoked 1-1.5 ppd x 18 years, quit 30 years ago occ. glass of wine retired and lives with companion last dental visit in family history: 2 daughters with aortic valve problems physical exam: pulse:69 resp:18 o2 sat: 96% b/p 120/62 ht: 5 feet 10 inches wt: 225 lbs general:nad skin: dry heent: perrla eomi anicteric sclera;op unremarkable neck: supple full rom no jvd appreciated chest: lungs clear bilaterally ; healed large keloid sternotomy scar heart: rrr irregular murmur grade __iii/vi radiates to carotids abdomen: soft non-distended non-tender bowel sounds + ; no hsm; well-healed ruq scar extremities: warm , well-perfused edema _none____ nodule b dorsum of feet varicosities: none neuro: grossly pulses: femoral right: 2+ left:2+ dp right:2+ left:2+ pt : np left:np radial right: 2+ left:2+ carotid bruit :murmur radiates to b carotids pertinent results: wbc-6.9 rbc-3.85* hgb-11.4* hct-35.9* rdw-13.9 plt ct-173 pt-14.3* ptt-22.9 inr(pt)-1.2* glucose-103* urean-21* creat-1.0 na-141 k-4.9 cl-103 hco3-24 albumin-4.5 %hba1c-5.8 eag-120 . tee, prebypass: no atrial septal defect is seen by 2d or color doppler. there is mild regional left ventricular systolic dysfunction with hypokinesis of the distal heart segments and apex. the right ventricular cavity is mildly dilated with mild global free wall hypokinesis. the ascending is mildly dilated. a bioprosthetic aortic valve prosthesis is present. the prosthetic aortic valve leaflets are thickened. there is severe aortic valve stenosis (valve area 0.8-1.0cm2). mild to moderate (+) aortic regurgitation is seen. the aortic regurgitation jet is eccentric. the mitral valve leaflets are mildly thickened. mild to moderate (+) mitral regurgitation is seen. . chest x-ray: there continues to be a small left-sided pleural effusion and retrocardiac opacity that could be due to volume loss/effusion/infiltrate. there is a small right effusion. compared to the prior study there is no new infiltrate. . wbc-8 rbc-3.05* hgb-9.1* hct-28.3* plt ct-271 wbc-12.4* plt ct-228 wbc-11.5* hgb-9.6* hct-29.3* plt ct-215 wbc-10.6 rbc-2.89* hgb-8.9* hct-26.6* plt ct-204 pt-21.4* ptt-91.5* inr(pt)-2.0* pt-18.6* ptt-71.2* inr(pt)-1.7* pt-17.3* ptt-92.8* inr(pt)-1.5* pt-17.3* ptt-54.1* inr(pt)-1.5* pt-17.6* ptt-49.6* inr(pt)-1.6* urean-23* creat-0.7 na-142 k-4.0 cl-103 hco3-31 angap-12 urean-29* creat-0.8 na-140 k-4.1 cl-102 hco3-29 angap-13 urean-34* creat-0.7 na-138 k-3.7 cl-101 hco3-30 angap-11 urean-42* creat-0.8 na-138 k-3.6 cl-103 hco3-29 angap-10 06:50am blood mg-2.1 brief hospital course: mr. was admitted to the on for surgical management of his bioprosthetic aortic valve disease. the following day, he was taken to the operating room where he underwent redo sternotomy and replacement of his aortic valve using a 23mm st. regent mechanical valve. please see operative note for details. postoperatively he was taken to the intensive care unit for monitoring. over the next 24 hours, he awoke neurologically and was extubated without incident. he was transferred to the floor on pod #1 to begin increasing his activity level. low dose beta blockade was resumed and coumadin started for his mechanical valve. amiodarone was also started for postoperative atrial fibrillation. chest tubes and pacing wires were removed per protocol without complication. warfarin was dosed daily and titrated for a goal inr between 2.5 to 3.0. due to a subtherapeutic inr, he temporarily required heparin bridge. over several days, he continued to make clinical improvments with diuresis. once his inr reached 2.0, he was cleared for discharge to rehab. prior to discharge, arrangements were made with dr. to monitor pt/inr following discharge from rehab. he was discharged to nursing and rehab facility on postoperative day nine. at discharge, he remained in a rate controlled atrial fibrillation. medications on admission: amiodarone 200 mg daily ezetimibe-simvastatin 10 mg-80 mg tablet - 1 tablet(s) by mouth daily gemfibrozil 600 mg twice a day glipizide 5 mg daily levothyroxine 50 mcg daily lisinopril 10 mg daily metformin 500 mg twice a day metoprolol tartrate 25 mg twice a day aspirin 81 mg daily cholecalciferol (vitamin d3) 1,000 unit capsule - 1 capsule(s) by mouth daily discharge medications: 1. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 2. levothyroxine 50 mcg tablet sig: one (1) tablet po daily (daily). 3. ranitidine hcl 150 mg tablet sig: one (1) tablet po daily (daily). 4. amiodarone 200 mg tablet sig: one (1) tablet po once a day. 5. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day): hold for hr < 60 and/or sbp < 95. 6. glipizide 5 mg tablet sig: one (1) tablet po bid (2 times a day). 7. vytorin 10-40 10-40 mg tablet sig: one (1) tablet po daily (). 8. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po every 6-8 hours as needed for pain. 9. warfarin 5 mg tablet sig: one (1) tablet po once a day: take inr between 2.5 to 3.0. 10. lasix 40 mg tablet sig: one (1) tablet po once a day for 7 days: please take with kcl. 11. potassium chloride 10 meq tablet extended release sig: two (2) tablet extended release po once a day for 7 days: please take with lasix. discharge disposition: extended care facility: nursing center - discharge diagnosis: bioprosthetic aortic valve stenosis - s/p redo avr prior bovine aortic valve replacement/maze procedure atrial fibrillation hypothyroidism obstructive sleep apnea on cpap noninsulin dependent diabetes mellitus discharge condition: alert and oriented x3 nonfocal ambulating with steady gait incisional pain managed with oral analgesics incisions: sternal - healing well, no erythema or drainage discharge instructions: 1) please shower daily including washing incisions gently with mild soap, no baths or swimming until cleared by surgeon. look at your incisions daily for redness or drainage. 2) please no lotions, cream, powder, or ointments to incisions. 3) each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart provided. 4) no driving for approximately one month and while taking narcotics. driving will be discussed at follow up appointment with surgeon when you will likely be cleared to drive. 5) no lifting more than 10 pounds for 10 weeks 6) please call with any questions or concerns . labs: pt/inr for coumadin ?????? indication mechanical aortic valve and atrial fibrillation. goal inr: 2.5 - 3.0. first pt/inr draw: results to: dr. ** please arrange appopriate coumadin followup with dr. prior to discharge from rehab. ** . **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** followup instructions: you are scheduled for the following appointments surgeon: dr on at 1:30pm cardiologist: dr on at 9:30am wound check on at 10:30am in please call to schedule appointments with your primary care dr. (in weeks **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** . labs: pt/inr for coumadin ?????? indication mechanical aortic valve and atrial fibrillation. goal inr: 2.5 - 3.0. first pt/inr draw: results to: dr. ** please arrange appopriate coumadin followup with dr. prior to discharge from rehab. ** procedure: extracorporeal circulation auxiliary to open heart surgery open and other replacement of aortic valve diagnoses: obstructive sleep apnea (adult)(pediatric) esophageal reflux diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified acquired hypothyroidism cardiac complications, not elsewhere classified atrial fibrillation aortic valve disorders mechanical complication due to heart valve prosthesis surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation long-term (current) use of anticoagulants encounter for therapeutic drug monitoring solitary pulmonary nodule 

Answer: The patient is high likely exposed to