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: no known allergies / adverse drug reactions attending: chief complaint: dyspnea on exertion major surgical or invasive procedure: aortic valve replacement(21mm pericardial), two vessel coronary artery bypass grafting(left internal mammary to left anterior descending artery, vein graft to ramus), and aortic endarterectomy. history of present illness: mr. is a 82 year old gentleman with symptomatic coronary artery disease and aortic stenosis. in , dr. deemed him to be too high risk for surgery due to extensive aortic calcification. he subequently underwent aortic valvuloplasty in . due to recurrent symptoms, he underwent repeat cardiac cathterization in which revealed left main disease with an instent restenosis of ramus. given his severe aortic stenosis and left main lesion, he was deemed too high risk for percutaneous intervention. he was subquently referred to dr. for off pump cabg, with the possibility of aortic valve replacement. after extensive discussion with the patient and his family, he agreed to proceed with high risk surgery. past medical history: severe aortic stenosis, s/p aortic valvuloplasty coronary artery disease, s/p bms to ramus in history of tia esrd requiring hemodialysis pulmonary hypertension chronic diastolic congestive heart failure hypertension dyslipidemia type ii diabetes mellitus anemia history of bladder calculi renal osteodystrophy social history: lives with: wife occupation: retired tobacco: denies etoh: social family history: no family history of early mi or sudden cardiac death physical exam: admission physical exam: pulse: 85 resp: 18 o2 sat: 100%ra b/p right: left: 144/76 height: 5'5" weight: 64kg general: elderly male in no acute distress skin: dry intact heent: perrla eomi neck: supple full rom chest: lungs clear bilaterally heart: rrr irregular murmur iii/vi sem abdomen: soft non-distended non-tender bowel sounds + extremities: warm , well-perfused edema varicosities: none neuro: grossly intact left upper arm fistula pulses: femoral right: 2+ left: 2+ dp right: 2+ left: 2+ pt : 2+ left: 2+ radial right: 2+ left: 2+ carotid bruit right:- left:- pertinent results: admits labs: wbc-7.2 rbc-4.52* hgb-10.5* hct-32.0* plt ct-117* pt-12.7 ptt-25.3 inr(pt)-1.1 glucose-187* urean-33* creat-4.8*# na-136 k-4.0 cl-91* hco3-33* alt-22 ast-21 ld(ldh)-252* alkphos-57 amylase-118* totbili-0.6 lipase-53 albumin-2.5* %hba1c-6.5* . intraop tee: pre-cpb: the left atrium is mildly dilated. no thrombus is seen in the left atrial appendage. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy. overall left ventricular systolic function is low normal (lvef 50-55%). right ventricular chamber size and free wall motion are normal. the ascending aorta is mildly dilated. the aortic root and ascending aorta have focal calcifications. there are simple atheroma in the descending thoracic aorta. no thoracic aortic dissection is seen. a guidewire is seen in the descending aorta during femoral cannulation. there are three aortic valve leaflets. the aortic valve leaflets are severely thickened/deformed. there is critical aortic valve stenosis (valve area <0.8cm2). mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is significant mitral annular calcification. there is prolapse of the anterior mitral leaflet with a posteriorly directly mr jet with coanda effect. at least moderate (2+) mitral regurgitation is seen. post-cpb: a bioprosthetic valve is present in the aortic position. the leaflets appear to move normally. the peak gradient across the aortic valve is 29mmhg, the mean gradient is 12mmhg. there is a small paravalvular leak which improved with protamine administration. lv systolic function appeared severely depressed immediately after separation from bypass and slowly improved with administration of inotropes. estimated ef after chest closure is 30-35%. the mr remains an eccentric jet with coanda effect. there is moderate to severe mr. there is no evidence of aortic dissection. . postop portable tte: there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is low normal (lvef 50%). the right ventricular free wall is hypertrophied. right ventricular chamber size is normal. a bioprosthetic aortic valve prosthesis is present. the mitral valve leaflets are mildly thickened. an eccentric, posteriorly directed jet of moderate (2+) mitral regurgitation is seen. due to the eccentric nature of the regurgitant jet, its severity may be significantly underestimated (coanda effect). the tricuspid valve leaflets are mildly thickened. moderate tricuspid regurgitation is seen. there is no pericardial effusion. . brief hospital course: mr. was admitted and underwent routine preadmission testing and hemodialysis. on he was taken to the operating room and underwent aortic valve replacement(21mm pericardial)/two vessel coronary artery bypass grafting(left internal mammary to left anterior descending artery, vein graft to ramus), and aortic endarterectomy. cardiopulmonary bypass time= 245 minutes. cross clamp time=180 minutes. please see operative note for surgical details. he tolerated the procedure well and was transferred to the cvicu intubated and sedated on multiple pressors and inotropy to optimize cardiac function. renal continued to follow postoperatively for his esrd/dialysis needs. mr. was kept intubated to protect his airway while maintaining stable hemodynamics until pod# 5. pressors and inotropy were weaned off. beta-blockers/statin/aspirin and diuresis was initiated. postoperative atrial fibrillation was treated with amiodarone and beta-blocker. prolonged conversion pauses and tachy-brady syndrome became apparant. electrophysiology was consulted and a temporary transvenous wire was placed. beta-blockade and amio were held to allow for recovery. per ep these agents were slowly reintroduced and tolerated. transvenous pacing wire was discontinued on . ultimately a permanent pacemaker was deemed unnecessary. anticoagulation was initiated with coumadin secondary to paroxysmal atrial fibrillation. supratherapeutic inr was treated with holding anticoagulation, reversal with vitamin k and fresh frozen plasma, and gentle dosing with coumadin was resumed. all lines and drains were discontinued in a timely fashion. antibiotics for clostridium difficile was initiated. a midline was placed for access. speech and swallow was consulted for swallowing evaluation. pod# 11 he was transferred to the step down unit for further monitoring. physical therapy was consulted for evaluation of strength and mobility. hemodialysis was conducted per renal. he continued to progress and on pod# 17 he was cleared for discharge to rehabilitation at for further progress in strength, mobility, and daily activities. dr. to follow coumadin dosing/inr once mr has been discharged from rehab. all follow up appointments were advised.target inr 2.0-2.5 for a fib. medications on admission: renal caps - 1 mg capsule - 1 capsule(s) by mouth every morning labetalol - 200 mg tablet - 1 tablet(s) by mouth every evening simvastatin - 40 mg tablet - 1 tablet(s) by mouth at night valsartan - 160 mg tablet - 1 tablet(s) by mouth every morning (held on dialysis days) aspirin - 81 mg tablet, chewable - 1 tablet(s) by mouth every morning discharge medications: 1. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 2. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 4. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 5. metoprolol tartrate 50 mg tablet sig: one (1) tablet po tid (3 times a day). 6. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 7. lanthanum 500 mg tablet, chewable sig: one (1) tablet, chewable po tid w/meals (3 times a day with meals). 8. valsartan 80 mg tablet sig: two (2) tablet po daily (daily). 9. coumadin 1 mg tablet sig: dose for goal inr of 2.0-2.5 tablets po once a day: dose today 1 mg only;all further dosing per rehab provider;goal inr is 2.0-2.5 for atrial fibrillation. 10. insulin sliding scale and daily dose please see attached sliding scale and daily insulin dose. 11. telemetry please keep on telemetry 12. vancomycin 125 mg capsule sig: one (1) capsule po every six (6) hours for 8 days: dosing through ; for a 2 week course. discharge disposition: extended care facility: @ hospital discharge diagnosis: aortic stenosis, coronary artery disease - s/p avr and cabg heavily calcified aorta end stage renal disease, requires hemodialysis pulmonary hypertension chronic diastolic congestive heart failure hypertension dyslipidemia type ii diabetes mellitus anemia postop sick sinus syndrome postop c. difficile 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 leg right/left - healing well, no erythema or drainage. 1+ edema discharge instructions: 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 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 resume hemodialysis on tuesday/thursday/saturday schedule. 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** **vna to draw daily inr and call/fax results to clinic followup instructions: you are scheduled for the following appointments surgeon: dr. phone: date/time: 1:00 cardiologist: dr. # , appointment arranged for at 9am. please call to schedule appointments with your primary care dr. in weeks dr. to follow inr/coumadin dosing via clinic **once discharged from rehab. clinic # daily labs: pt/inr for coumadin ?????? indication: paroxysmal atrial fibrillation goal inr 2-2.5 please fax- coumadin doses/inr levels to the clinic upon discharge results to phone fax **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** md procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more single internal mammary-coronary artery bypass extracorporeal circulation auxiliary to open heart surgery hemodialysis (aorto)coronary bypass of one coronary artery insertion of temporary transvenous pacemaker system open and other replacement of aortic valve with tissue graft endarterectomy, aorta procedure on single vessel diagnoses: thrombocytopenia, unspecified anemia in chronic kidney disease end stage renal disease renal dialysis status coronary atherosclerosis of native coronary artery congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled cardiac complications, not elsewhere classified atherosclerosis of aorta atrial fibrillation aortic valve disorders other chronic pulmonary heart diseases percutaneous transluminal coronary angioplasty status hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other and unspecified hyperlipidemia atrioventricular block, complete personal history of other malignant neoplasm of skin alkalosis 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 cardiogenic shock intestinal infection due to clostridium difficile sinoatrial node dysfunction chronic diastolic heart failure renal osteodystrophy 

Answer: The patient is high likely exposed to