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: lasix / penicillins / gentamicin / lipitor / vancomycin / tetracycline / levaquin / warfarin / shellfish derived attending: chief complaint: dyspnea on exertion major surgical or invasive procedure: redo sternotomy mitral valve replacement (27 tissue) history of present illness: 70 year-old female with history of mitral stenosis s/p mitral valve commissurotomy , chronic atrial fibrillation admitted for pre-operative iv heparin. past medical history: rheumatic fever mitral stenosis atrial fibrillation hyperlipidemia left breast ca gerd gastric polyps disease right ankle fracture hypothyroid s/p mitral valve commissurotomy at with dr. s/p lumpectomy and xrt for l breast ca cholecystectomy uterine suspension with lysis of colon adhesions appendectomy tonsillectomy r eye cataract surgery social history: occupation:retired lives with: husband :quit 45 years ago, smoked for 5 yrs family history: father with age 63, mother with angina, brother with cad physical exam: pulse: 64 irregular resp: o2 sat: 98% ra b/p right: 143/83 left: 156/90 height: 5'5" weight:146 lbs 66.4 kg general: skin: dry intact heent: perrla eomi neck: supple full rom chest: lungs clear bilaterally heart: rrr irregular murmur abdomen: soft non-distended non-tender bowel sounds + extremities: warm , well-perfused edema varicosities: none neuro: grossly intact pulses: femoral right:2 left:2 dp right:2 left:2 pt :2 left:2 radial right:2 left:2 carotid bruit right:n left:n pertinent results: 09:30am blood wbc-15.0* rbc-3.53* hgb-9.7* hct-30.7* mcv-87 mch-27.4 mchc-31.5 rdw-14.9 plt ct-128* 01:35pm blood wbc-7.9 rbc-4.60 hgb-13.0 hct-40.5 mcv-88 mch-28.3 mchc-32.2 rdw-14.1 plt ct-238 01:46pm blood neuts-78.7* lymphs-19.2 monos-1.2* eos-0.6 baso-0.3 09:30am blood plt ct-128* 09:30am blood pt-15.7* inr(pt)-1.4* 01:35pm blood glucose-92 urean-15 creat-0.8 na-141 k-4.1 cl-101 hco3-32 angap-12 09:30am blood glucose-197* urean-11 creat-0.7 na-137 k-3.8 cl-98 hco3-30 angap-13 01:35pm blood alt-29 ast-24 ld(ldh)-232 alkphos-70 amylase-48 01:35pm blood lipase-36 01:35pm blood albumin-4.6 calcium-9.6 phos-3.6 mg-2.2 , (complete) done at 12:26:49 pm final referring physician information , r. , division of cardiothorac , status: inpatient dob: age (years): 71 f hgt (in): bp (mm hg): / wgt (lb): hr (bpm): bsa (m2): indication: intraoperative tee for mvr icd-9 codes: 427.31, 440.0, 394.2, 424.2 test information date/time: at 12:26 interpret md: , md test type: tee (complete) son: , md doppler: full doppler and color doppler test location: anesthesia west or cardiac contrast: none tech quality: adequate tape #: 2009aw4-: machine: ie33 echocardiographic measurements results measurements normal range left atrium - four chamber length: *7.9 cm <= 5.2 cm left ventricle - inferolateral thickness: 0.8 cm 0.6 - 1.1 cm left ventricle - diastolic dimension: 5.0 cm <= 5.6 cm left ventricle - ejection fraction: 50% >= 55% aorta - ascending: 2.7 cm <= 3.4 cm aorta - descending thoracic: 1.7 cm <= 2.5 cm mitral valve - peak velocity: 1.4 m/sec mitral valve - mean gradient: 3 mm hg mitral valve - mva (p t): 2.1 cm2 findings left atrium: marked la enlargement. elongated la. no spontaneous echo contrast in the body of the laa. cannot exclude laa thrombus. all four pulmonary veins identified and enter the left atrium. right atrium/interatrial septum: dilated ra. a catheter or pacing wire is seen in the ra and extending into the rv. no asd by 2d or color doppler. prominent eustachian valve (normal variant). left ventricle: wall thickness and cavity dimensions were obtained from 2d images. normal lv wall thickness and cavity size. normal regional lv systolic function. low normal lvef. right ventricle: dilated rv cavity. borderline normal rv systolic function. aorta: focal calcifications in aortic root. normal ascending aorta diameter. simple atheroma in aortic arch. normal descending aorta diameter. simple atheroma in descending aorta. aortic valve: mildly thickened aortic valve leaflets (3). no as. no ar. mitral valve: severely thickened/deformed mitral valve leaflets. characteristic rheumatic deformity of the mitral valve leaflets with fused commissures and tethering of leaflet motion. moderate mitral annular calcification. moderate thickening of mitral valve chordae. mild valvular ms (mva 1.5-2.0cm2). eccentric mr jet. severe (4+) mr. tricuspid valve: mildly thickened tricuspid valve leaflets. mild tr. pulmonic valve/pulmonary artery: pulmonic valve not well seen. physiologic (normal) pr. general comments: a tee was performed in the location listed above. i certify i was present in compliance with hcfa regulations. the patient was under general anesthesia throughout the procedure. no tee related complications. the rhythm appears to be atrial fibrillation. results were personally reviewed with the md caring for the patient. conclusions pre bypass the left atrium is markedly dilated. the left atrium is elongated. no spontaneous echo contrast is seen in the body of the left atrium or left atrial appendage. due to image quality, a left atrial appendage thrombus cannot be completely excluded. the right atrium is dilated. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thicknesses and cavity size are normal. overall left ventricular systolic function is low normal (lvef 50-55%). the right ventricular cavity is dilated with borderline normal free wall function. there are simple atheroma in the aortic arch. there are simple atheroma in the descending thoracic aorta. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are severely thickened/deformed. the mitral valve shows characteristic rheumatic deformity. there is moderate thickening of the mitral valve chordae. there is mild valvular mitral stenosis (area 2.0cm2). an eccentric, posteriorly directed jet of severe (4+) mitral regurgitation is seen originating between the a1 and p1 mitral valve scallops. the tricuspid valve leaflets are mildly thickened. dr. was notified in person of the results in the operating room at the time of the study. post bypass the patient is being av paced. epinephrine was used initially when separating from bypass but then quickly weaned. the right ventricle displays normal systolic function, though the amount of tricuspid regurgitation is now moderate and so intrinsic right ventricular function may be somewhat less than normal. the left ventricle displayed severe lateral wall hypokinesis during initial separation from bypass but this quickly resolved. left ventricular systolic function was then normal (> 55%). there is a bioprosthesis in the mitral position. it is well seated and displays normal leaflet function. the maximum pressure gradient across the valve was 12 mmhg and the mean gradient was 4 mmhg at a cardiac output of 4 liters/minute. there is trace valvular mitral regurgitation. the thoracic aorta appears intact. i certify that i was present for this procedure in compliance with hcfa regulations. electronically signed by , md, interpreting physician 15:00 brief hospital course: admitted for preoperative workup and heparin bridge from coumadin. on was brought to the operating room and underwent mitral valve replacement. see operative report for further details. she received vancomycin for perioperative antibiotics because she was in the hospital preoperatively. post operatively she was transferred to the intensive care unit for hemodynamic management. in the first twenty four hours she was weaned from sedation, awoke neurologically intact, and was extubated without complications. she was transferred to the floor on postoperative day one and her coumadin was resumed for atrial fibrillation. her inr was 1.6 on day of discharge and was rec'ing 4 mg coumadin. physical therapy worked with her on strength and mobility. she continued to do well and was ready for discharge home with services on postoperative day five. medications on admission: zetia 10mg daily/qam coumadin 3mg tablet daily/qpm last dose ( coumadin clinic) edecrin 25mg daily/qam digoxin 0.125mg daily/qam levoxyl 50mcg daily/qam clindamycin 600mg /prn prophylactic for invasive/dental procedures discharge medications: 1. outpatient work pt/inr for atrial fibrillation with goal inr 2.0-2.5. results to dr office first draw sunday 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*0* 3. ezetimibe 10 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 4. digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 5. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). disp:*30 tablet, delayed release (e.c.)(s)* refills:*0* 6. levoxyl 50 mcg tablet sig: one (1) tablet po daily (). disp:*30 tablet(s)* refills:*0* 7. ranitidine hcl 150 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 8. ethacrynic acid 25 mg tablet sig: one (1) tablet po bid (2 times a day): take 2 times per day for 10 dasy then decrease to once daily ongoing. disp:*60 tablet(s)* refills:*2* 9. metoprolol tartrate 25 mg tablet sig: 1.5 tablets po bid (2 times a day). disp:*90 tablet(s)* refills:*2* 10. tramadol 50 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. disp:*65 tablet(s)* refills:*0* 11. coumadin 1 mg tablet sig: as directed tablet po once a day: take as directed by dr. based on inr goal 2-2.5 . disp:*30 tablet(s)* refills:*2* discharge disposition: home with service facility: vna discharge diagnosis: mitral stenosis s/p mvr rheumatic fever atrial fibrillation hyperlipidemia left breast ca gerd gastric polyps disease right ankle fracture hypothyroid-new s/p mitral valve commissurotomy at with dr. s/p lumpectomy and xrt for l breast ca cholecystectomy uterine suspension with lysis of colon adhesions appendectomy tonsillectomy r eye cataract surgery discharge condition: good discharge instructions: please shower daily including washing incisions gently with mild soap, no baths or swimming monitor wounds for infection and report any redness, warmth, swelling, tenderness or drainage please take temperature each evening and report any fever 100.5 or greater report any weight gain of greater than 2 pounds in 24 hours or 5 pounds in a week no creams, lotions, powders, or ointments to incisions no driving for approximately one month until follow up with surgeon no lifting more than 10 pounds for 10 weeks please call with any questions or concerns please wear bra to reduce pulling on incision, avoid rubbing on lower edge followup instructions: please call to schedule appointments surgeon dr in 4 weeks primary care dr in weeks cardiologist dr in weeks wound check appointment - 6 () - your nurse will schedule pt/inr for atrial fibrillation with goal inr 2.0-2.5. results to dr office first draw sunday procedure: extracorporeal circulation auxiliary to open heart surgery open and other replacement of mitral valve with tissue graft diagnoses: anemia, unspecified esophageal reflux unspecified acquired hypothyroidism atrial fibrillation other chronic pulmonary heart diseases personal history of malignant neoplasm of breast other and unspecified hyperlipidemia long-term (current) use of anticoagulants diseases of tricuspid valve disorders of bilirubin excretion mitral stenosis with insufficiency heart failure, unspecified 

Answer: The patient is high likely exposed to