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: codeine attending: chief complaint: dyspnea on exertion major surgical or invasive procedure: 1. bentall procedure with a 25-mm st. medical valve conduit, mechanical. 2. mitral valve replacement with a 33-mm st. medical mechanical valve. history of present illness: this is a 66yo male with marfans syndrome. known mitral valve prolapse with mitral regurgitation and history of paroxysmal atrial fibrillation. he is currently preop for asc ao/avr/?mvr vs bentall/avr/?mvr. he currently complains of chronic dyspnea with modest exertion. he denies chest pain, orthopnea, pnd, pedal edema, lightheadedness and syncope. he attributes his shortness of breath to his active smoking. he is able to perform his routine adl without difficulty.referred for surgery. past medical history: marfans syndrome aortic insufficiency mitral regurgitation non-obstructive coronary artery disease cardiomyopathy, s/p aicd/pacemaker paroxysmal atrial fibrillation- now sr mitral valve prolapse with mitral regurgitation history of gi bleed x2 (last )-stopped asa dyslipidemia emphysema - noted on chest ct scan prostate ca ( preop) niddm tobacco abuse- quit past surgical history: aicd/pacemaker appendectomy right biceps repair b cataract surgs cystoscopies - scar tissue removal social history: lives with:wife occupation:disabled since age 60 tobacco: active smoker; 1 ppd-quit etoh:sober for 4 years family history: mother died of mi at 82; father with mi at 62; brother with mi at 59 physical exam: pulse:64 resp: 16 o2 sat:97%-ra b/p right: 130/63 left: 134/64 height: 74 inches weight: 218 lbs general:nad, lying in bed skin: dry intact heent: perrla eomi iregular noted right eye;anicteric sclera,op unremarkable; edentulous neck: supple full rom no jvd appreciated chest: lungs no rales or rhonchi heart: rrr irregular murmur: 3/6 sem abdomen: soft non-distended non-tender +bs no hsm; healed rlq scar extremities: warm , well-perfused edema-none; healed repair of large (nearly circumferential) bicep scar; b finger clubbing noted varicosities: mild ble spider veins neuro: grossly intact; nonfocal exam; mae strengths pulses: femoral right: 2+ left:2+ dp right: np left:np pt : 2+ left: 2+ radial right: 2+ left:2+ carotid bruit: murmur radiates to b carotids pertinent results: intra-op tee pre-cpb: no thrombus is seen in the left atrial appendage. no atrial septal defect is seen by 2d or color doppler. the left ventricular cavity is mildly dilated. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic root is moderately dilated at the sinus level. the descending thoracic aorta is mildly dilated. there are simple atheroma in the descending thoracic aorta. no thoracic aortic dissection is seen. there are three aortic valve leaflets. to severe (3+) aortic regurgitation is seen. the mitral valve leaflets are myxomatous and severely redundant, with atrialization of insertion sites. there is /severe bileaflet mitral valve prolapse. there is a mass on the atrial side of the a1 scallop of the mitral valve, near the base of the leaflet. this mass appears to have mobile fronds and measures 1cm x 0.7cm. the mr jet occurs mostly in the area between a3-p3. there is a central component and an eccentric, posteriorly directed component. the mr . due to the eccentric nature of the regurgitant jet, its severity may be underestimated (coanda effect). post-cpb: a bileaflet mechanical prosthetic valve in the aortic position. the valve appears well-seated with normal leaflet motion. there are the normal washing jets. there is no apparent paravalvular leak or ai. (the valve can only be seen in transgastric views, it is obscured by acoustic shadowing in esophageal views.) the peak gradient across the valve is 18mmhg, the mean gradient is 9mmhg with a co of 6. there is a tube graft seen in the aortic root and ascending aorta. there is a bileaflet mechanic valve in the mitral position. the valve appears well-seated with normal leaflet motion. there are the normal washing jets, and no paravalvular leak. the lv systolic function appears mildly depressed, estimated ef=40-45%. (the patient underwent a long bypass run and is on norepi and epi infusions.) the rv systolic function appears low normal. there is no evidence of aortic dissection. 04:55am blood wbc-14.1* rbc-2.93* hgb-9.1* hct-26.2* mcv-89 mch-31.1 mchc-34.8 rdw-13.9 plt ct-425 11:40pm blood wbc-12.4* rbc-2.99* hgb-9.4* hct-26.6* mcv-89 mch-31.3 mchc-35.1* rdw-13.9 plt ct-450* 04:20am blood pt-32.0* ptt-86.1* inr(pt)-3.2* 07:55am blood pt-29.1* ptt-78.3* inr(pt)-2.8* 04:55am blood pt-25.7* ptt-85.6* inr(pt)-2.4* 11:40pm blood pt-24.5* ptt-63.1* inr(pt)-2.3* 05:10am blood pt-22.7* ptt-128.4* inr(pt)-2.1* 03:24pm blood pt-18.7* ptt-36.4* inr(pt)-1.7* 04:35am blood pt-18.0* ptt-60.3* inr(pt)-1.6* 09:13am blood pt-17.7* ptt-85.2* inr(pt)-1.6* 03:00am blood pt-17.7* ptt-85.5* inr(pt)-1.6* 06:15pm blood pt-16.1* ptt-41.1* inr(pt)-1.4* 06:05am blood pt-14.3* ptt-25.4 inr(pt)-1.2* 06:40am blood pt-13.9* ptt-23.0 inr(pt)-1.2* 04:42pm blood pt-13.3 inr(pt)-1.1 05:15am blood pt-14.4* ptt-25.3 inr(pt)-1.2* 05:08pm blood pt-15.0* ptt-33.3 inr(pt)-1.3* 04:10pm blood pt-13.8* ptt-22.1 inr(pt)-1.2* brief hospital course: the patient was brought to the operating room on where the patient underwent a bentall procedure with a 25-mm st. medical valved conduit, mechanical, as well as mitral valve replacement with a 33-mm st. medical mechanical valve with dr. . overall the patient tolerated the procedure well and post-operatively was transferred to the cvicu in stable condition for recovery and invasive monitoring. pod 1 found the patient extubated, alert and oriented and breathing comfortably. the patient was neurologically intact and hemodynamically stable, weaned from inotropic and vasopressor support. beta blocker was initiated and the patient was gently diuresed toward the preoperative weight. the patient was anti-coagulated with a heparin bridge and coumadin for the mechanical valves. the patient was transferred to the telemetry floor for further recovery. chest tubes and pacing wires were discontinued without complication. the patient was evaluated by the physical therapy service for assistance with strength and mobility. was consulted for diabetes management. cipro was started for a +urinalysis, but then discontinued when urine culture was negative. the patient became therapeutic on coumadin after several days, and he was cleared for discharge to home with vna. by the time of discharge on pod 12, the patient was ambulating freely, the wound was healing and pain was controlled with oral analgesics. the patient was discharged home with vna in good condition with appropriate follow up instructions. glipizide, metformin and insulin were started on this admission. the patient is instructed to keep a log of his blood sugars and report them to his pcp. medications on admission: ***warfarin 5mg alternates with 7.5 mg *** fenofibrate 160 qd, digoxin 0.125 qd, lisinopril 5 qd, simvastatin 40 qd, coreg 12.5 , lasix 10 qd, glyburide 2.5 , fish oil 1000mg qd discharge medications: 1. outpatient lab work labs: pt/inr coumadin for mechanical mvr and mechanical avr goal inr 2.5-3.5 first draw day after discharge, then please do inr checks monday, wednesday, and friday for 2 weeks then decrease as directed by dr. at the medical group results to phone (nurse's anti-coagulation line) 2. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 3. simvastatin 40 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. fenofibrate micronized 145 mg tablet sig: one (1) tablet po daily (). disp:*30 tablet(s)* refills:*0* 6. furosemide 20 mg tablet sig: 0.5 tablet po once a day. disp:*15 tablet(s)* refills:*0* 7. carvedilol 6.25 mg tablet sig: three (3) tablet po bid (2 times a day). disp:*180 tablet(s)* refills:*0* 8. glipizide 10 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*0* 9. warfarin 5 mg tablet sig: one (1) tablet po once (once): dose will change daily for goal inr 2.5-3.5 for mechanical valves, dr. to manage. disp:*60 tablet(s)* refills:*0* 10. metformin 500 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*0* 11. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed for pain/fever. 12. insulin glargine 100 unit/ml (3 ml) insulin pen sig: fifteen (15) units subcutaneous at bedtime: 15 units at bedtime. disp:*qs units* refills:*2* 13. insulin lispro 100 unit/ml insulin pen sig: one (1) subcutaneous four times a day: per humalog sliding scale. disp:*qs * refills:*2* discharge disposition: home with service facility: all care vna of greater discharge diagnosis: marfans syndrome aortic insufficiency mitral regurgitation non-obstructive coronary artery disease cardiomyopathy, s/p aicd/pacemaker paroxysmal atrial fibrillation- now sr mitral valve prolapse with mitral regurgitation history of gi bleed x2 (last )-stopped asa dyslipidemia emphysema - noted on chest ct scan prostate ca ( preop) niddm tobacco abuse- quit past surgical history: aicd/pacemaker appendectomy right biceps repair b cataract surgs cystoscopies - scar tissue removal discharge condition: alert and oriented x3 nonfocal ambulating, gait steady sternal pain managed with oral analgesics sternal incision - healing well, no erythema or drainage no edema discharge instructions: please shower daily including washing incisions gently with mild soap, no baths or swimming, and look at your incisions please no lotions, cream, powder, or ointments to incisions each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart no driving for approximately one month and while taking narcotics, will be discussed at follow up appointment with surgeon when you will be able to drive no lifting more than 10 pounds for 10 weeks please call with any questions or concerns **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: wound check at cardiac surgery office surgeon dr. 1:30 cardiologist dr. derby at 3:30pm primary care dr. - to follow up for diabetes management and referral to endocrine clinic **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** labs: pt/inr coumadin for mechanical mvr and mechanical avr goal inr 2.5-3.5 first draw day after discharge, then please do inr checks monday, wednesday, and friday for 2 weeks then decrease as directed by dr. at the medical group results to phone (nurse's anti-coagulation line) procedure: extracorporeal circulation auxiliary to open heart surgery open and other replacement of aortic valve open and other replacement of mitral valve resection of vessel with replacement, thoracic vessels diagnoses: other primary cardiomyopathies coronary atherosclerosis of native coronary artery tobacco use disorder mitral valve disorders diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled hyposmolality and/or hyponatremia thoracic aneurysm without mention of rupture atrial fibrillation aortic valve disorders other and unspecified hyperlipidemia other emphysema long-term (current) use of anticoagulants automatic implantable cardiac defibrillator in situ marfan syndrome 

Answer: The patient is high likely exposed to