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: nifedipine / metoprolol attending: chief complaint: dyspnea on exertion major surgical or invasive procedure: - aortic valve replacement (23mm st. mechanical valve), ascending aorta replacement(30mm gelweave tube graft). history of present illness: 62 year old gentleman with a history of a bicuspid aortic valve and moderate aortic stenosis who has been followed by serial echocardiograms. he notes increasing exertional dyspnea and fatigue over the past several months. past medical history: bicuspid aortic valve aortic stenosis aortic aneurysm hypertension gerd social history: lives with: significant other, occupation: retired maintainance technician tobacco: none etoh: 7/week family history: father had bicuspid ao valve and avr-died 69yo of "clot". brother has bicuspid valve and arrhythmia problem. physical exam: pulse: 55 resp: 16 o2 sat: b/p right: 110/74 left: 118/70 height: 72" weight: 210 lbs general: nad, well appearing skin: dry intact heent: ncat perrla eomi neck: supple full rom jvd chest: lungs clear bilaterally heart: rrr irregular sys murmur abdomen: soft non-distended non-tender bowel sounds + extremities: warm , well-perfused edema -none right groin cath site- no erythema or drainage, tiny hematoma at puncture site, non-tender varicosities: none small spider veins neuro: grossly intact, nonfocal exam pulses: femoral right: 2+ left: 2+ dp right: 2+ left: 2+ pt : 2+ left: 2+ radial right: 2+ left: 2+ carotid bruit- right: left: none pertinent results: echo prebypass no spontaneous echo contrast is seen in the body of the left atrium or left atrial appendage. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef>55%). overall right ventricular systolic function is normal with normal free wall contractility. the aortic root is mildly dilated at the sinus level. there is a focal calcification in the aortic root measuring 8mm x 4mm. the ascending aorta is markedly dilated with a maximum diameter of 5.1 cm. the aortic arch is normal. the descending thoracic aorta is mildly dilated. there are simple atheroma in the descending thoracic aorta. the aortic valve is bicuspid with severely thickened/deformed aortic valve leaflets. a fibrinous echodensity is present on the aortic side of the non-coronary cusp of the aortic valve, consistent degenerative disease (suggest clinical correlation). there is severe aortic valve stenosis (valve area 0.8-1.0cm2). trace aortic regurgitation is seen. the mitral valve leaflets are structurally normal. mild (1+) mitral regurgitation is seen. there is no pericardial effusion. dr. was notified in person of the results at the time of the study. postbypass the patient is a-paced and is on an intermittent phenylephrine infusion. a new mechanical aortic valve is seen. it is well-seated with washing jets in the expected locations. there is trace aortic insufficiency in total. calculated aortic valve area is 2.0 cm2 with peak and mean gradients of 36 mmhg and 18 mmhg respectively at a cardiac output of about 6 liters/minute. an ascending aortic graft is seen. thoracic aorta is otherwise normal. left ventricular systolic function continues to be normal (lvef>55%). mild (1+) mitral regurgitation persists. pre-op 09:38am hgb-13.5* calchct-41 09:38am glucose-103 lactate-1.2 na+-137 k+-3.7 cl--105 12:30pm pt-16.2* ptt-31.0 inr(pt)-1.4* 12:30pm wbc-13.6*# rbc-2.70*# hgb-8.8*# hct-26.2*# mcv-97 mch-32.7* mchc-33.6 rdw-12.9 02:07pm urea n-10 creat-0.6 sodium-140 potassium-4.4 chloride-111* total co2-22 anion gap-11 07:15am blood wbc-6.9 rbc-2.88* hgb-9.4* hct-28.2* mcv-98 mch-32.8* mchc-33.5 rdw-13.0 plt ct-255# 09:25am blood pt-22.5* ptt-59.2* inr(pt)-2.1* 07:15am blood glucose-104* urean-7 creat-0.8 na-140 k-4.0 cl-104 hco3-29 angap-11 brief hospital course: mr. was admitted to the on for surgical management of his aortic valve stenosis and ascending aortic aneurysm. he was taken directly to the operating room where he underwent an aortic valve replacement with a 23mm st. mechanical valve and replacement of his ascending aorta. his bypass time was 89 minutes with a crossclamp time of 66 minutes. please see operative note for details. postoperatively he was taken to the intensive care unit for monitoring. over the next several hours, he awoke neurologically intact and was extubated. on pod 1 the patient was transferred to the telemetry floor for further recovery. all chest tubes and pacing wires and other lines were removed per cardiac surgery protocol. initially beta blocker was started at a low dose due to a systolic blood pressure. betablocker was increased slowly because the patient did have junctional rhythm with stable systolic pressure. low dose lisinopril was also resumed. he was diuresed toward the preoperative weight. he was started on coumadin with heparin bridge for aortic mechanical valve. the patient was evaluated by the physical therapy service for assistance with strength and mobility. by the time of discharge on pod #6 the patient was ambulating freely, the wound was healing and pain was controlled with oral analgesics and his inr was therapuetic. couamdin dosing will be followed by the clinic with a goal inr 2.5-3.0. the patient was discharged home with visitng nurse services in good condition with appropriate follow up instructions. medications on admission: lisinopril 5', hctz 25', protonix 40', mvi discharge medications: 1. aspirin 81 mg , delayed release (e.c.) sig: one (1) , delayed release (e.c.) po daily (daily). disp:*100 , delayed release (e.c.)(s)* refills:*2* 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 3. pantoprazole 40 mg , delayed release (e.c.) sig: one (1) , delayed release (e.c.) po q24h (every 24 hours). disp:*30 , delayed release (e.c.)(s)* refills:*0* 4. oxycodone-acetaminophen 5-325 mg sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. disp:*30 (s)* refills:*0* 5. acetaminophen 325 mg sig: two (2) po q4h (every 4 hours) as needed for pain. 6. potassium chloride 10 meq tab sust.rel. particle/crystal sig: two (2) tab sust.rel. particle/crystal po twice a day: 20meq x 1 week the 20meq qd x 1 week. disp:*45 tab sust.rel. particle/crystal(s)* refills:*0* 7. lisinopril 2.5 mg sig: one (1) po once a day. disp:*30 (s)* refills:*2* 8. metoprolol tartrate 25 mg sig: one (1) po tid (3 times a day). disp:*90 (s)* refills:*2* 9. lasix 20 mg sig: one (1) po twice a day: x 1 week then qd x1 week. disp:*21 (s)* refills:*0* 10. warfarin 5 mg sig: one (1) po once (once) for 1 doses. disp:*1 (s)* refills:*0* 11. warfarin 2 mg sig: md once a day: inr goal 2.5-3 mech avr. disp:*120 (s)* refills:*2* discharge disposition: home with service facility: vna, discharge diagnosis: aortic stenosis/ascending aortic aneurysm, s/p aortic valve replacement (23mm st. mechanical valve), ascending aorta replacement(30mm gelweave tube graft). hypertension gerd discharge condition: alert and oriented x3 nonfocal ambulating with steady gait incisional pain managed with percocet incisions: sternal - healing well, no erythema or drainage edema: trace bilateral pedal edema 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 4) no driving for approximately one month until follow up with surgeon 5) no lifting more than 10 pounds for 10 weeks 6) 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 surgeon: dr. at clinic at 1:45 pm, **please have cxr done prior to clinic appointment cardiologist dr. at 2:00 pm 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 goal inr 2.5-3.0 first draw then please do inr checks monday, wednesday, and friday for 2 weeks then as directed by dr through clinic results to coumadin clinic-fax procedure: extracorporeal circulation auxiliary to open heart surgery open and other replacement of aortic valve resection of vessel with replacement, thoracic vessels diagnoses: acidosis other iatrogenic hypotension anemia, unspecified esophageal reflux unspecified essential hypertension thoracic aneurysm without mention of rupture aortic valve disorders long-term (current) use of anticoagulants congenital insufficiency of aortic valve 

Answer: The patient is high likely exposed to