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 / erythromycin base / nickel attending: chief complaint: aortic stenosis, dilated ascending aorta major surgical or invasive procedure: aortic valve replacement (23mm on-x mechanical), 28mm gelweave graft ascending aorta, cor-matrix pericardial closure history of present illness: this 63 year old white female has a known bicuspid aortic valve and a history of rheumatic fever. serial echos have demonstrated progressive stenosis of the valve and now a dilated ascending aorta. she has had peripheral edema and increasing dyspnea with exertion. she was admitted now for operation having a catheterization in showing no coronary disease. past medical history: aortic stenosis h/o rheumatic fever hypertension ypercholesterolemia hypothyroidism rt foot fracture (s/p orif) s/p appendectomy s/p ovarian cyst removal osteoporosis social history: she is a widow, living alone. looking for part-time work. she used to manage medical records for . does not exercise. she is a widow, living alone. sister lives nearby. tobacco: quit etoh: wine/wk. family history: both parents died early of alcohol abuse. brother died of esophageal cancer. she has two sisters living. paternal uncle with sudden cardiac death in his 40's. physical exam: pulse: 92 b/p: right 116/65 left 116/54 resp: 18 o2 sat: 99% ra temp:98 height: 4'6" weight: 140 general: alert short statured female in nad skin: color pink, skin warm and dry. rash right chest and neck. belly button without erythema or drainage. there is a small lesion with scab noted. the skin is friable. heent: conjunctiva pink, left eye lower lid droop, left eye skin tag lower lid. oropharynx moist, dental bridge, good dentition. neck:supple, trachea midline. chest:clear heart: rrr, iii/vi sem, holosystolic. nl s1-s2 no s3 or s4 abd: soft, nontender, nondistended. (+)bowel sounds extremities: no cce. no varicosities neuro: alert and oriented, mildy anxious, gait steady, gross from pulses: right left radial 2 2 femoral 2 2 pt 2 2 dp 2 2 carotids no bruits, transmitted cardiac murmur bilaterally pertinent results: 02:57am blood wbc-7.1 rbc-2.93* hgb-8.9* hct-27.3* mcv-93 mch-30.4 mchc-32.6 rdw-13.0 plt ct-185 01:56pm blood wbc-10.1# rbc-2.46*# hgb-7.6*# hct-22.7*# mcv-92 mch-30.9 mchc-33.5 rdw-12.9 plt ct-151 02:57am blood pt-16.0* ptt-59.7* inr(pt)-1.5* 04:53am blood pt-14.2* ptt-45.0* inr(pt)-1.3* 04:30am blood pt-13.6* ptt-25.7 inr(pt)-1.3* 01:16am blood pt-15.3* ptt-31.8 inr(pt)-1.4* 02:57am blood glucose-124* urean-21* creat-0.5 na-136 k-3.5 cl-98 hco3-30 angap-12 03:45pm blood urean-11 creat-0.4 na-142 k-4.3 cl-115* hco3-21* angap-10 echocardiography report , portable tte (complete) done at 7:44:37 am final referring physician information , c. , status: inpatient dob: age (years): 63 f hgt (in): 56 bp (mm hg): 120/60 wgt (lb): 140 hr (bpm): 84 bsa (m2): 1.53 m2 indication: aortic valve disease. h/o cardiac surgery. left ventricular function. prosthetic valve function. icd-9 codes: v43.3, 424.1, 428.0 test information date/time: at 07:44 interpret md: , md test type: portable tte (complete) son: , md doppler: full doppler and color doppler test location: anesthesia west sicu/ctic/vicu contrast: none tech quality: suboptimal tape #: 2012aw000-0:00 machine: vivid q echocardiographic measurements results measurements normal range left ventricle - inferolateral thickness: *1.2 cm 0.6 - 1.1 cm left ventricle - diastolic dimension: 5.6 cm <= 5.6 cm left ventricle - ejection fraction: 30% to 35% >= 55% left ventricle - stroke volume: 51 ml/beat left ventricle - cardiac output: 4.29 l/min left ventricle - cardiac index: 2.80 >= 2.0 l/min/m2 aortic valve - peak velocity: 1.2 m/sec <= 2.0 m/sec aortic valve - lvot vti: 18 aortic valve - lvot diam: 1.9 cm mitral valve - e wave: 1.0 m/sec mitral valve - a wave: 0.8 m/sec mitral valve - e/a ratio: 1.25 mitral valve - e wave deceleration time: 147 ms 140-250 ms tr gradient (+ ra = pasp): >= 11 mm hg <= 25 mm hg findings this study was compared to the prior study of . left ventricle: mild symmetric lvh. normal lv cavity size. moderately depressed lvef. right ventricle: rv not well seen. aortic valve: mechanical aortic valve prosthesis (avr). avr well seated, normal leaflet/disc motion and transvalvular gradients. no ar. mitral valve: mildly thickened mitral valve leaflets. mild mitral annular calcification. no mr. tricuspid valve: tricuspid valve not well visualized. physiologic tr. normal pa systolic pressure. pericardium: no pericardial effusion. general comments: suboptimal image quality - poor echo windows. the rhythm appears to be a-v paced. results were personally conclusions there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is moderately depressed (lvef= 30-35%). a mechanical aortic valve prosthesis is present. the aortic valve prosthesis appears well seated, with normal leaflet/disc motion and transvalvular gradients. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. no mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. the right ventricle is not well but its function is probably normal. there is no pericardial effusion. compared with the prior study (images reviewed) of there is now global left ventricular systolic dysfunction which is new. electronically signed by , md, interpreting physician 18:00 brief hospital course: as a same day admit she went to the operating room where the aortic valve was replaced and the ascending aorta replaced using a 23mm on-x valve and a 28mm gelweave graft. the peicardium was closed with cor-matrix as well. she weaned from bypass on neo synephrine in stable condition. she weaned from the ventilator and pressor support easily. chest tubes and temporary pacing wires were removed per protocol. coumadin was started for the mechanical valve and heparin on pod 3. heaprain was stopped on pod#6 when her inr was therapeutic at 2.5 and was given 5mg of coumadin. she developed a junctional rhythm in the 70s postoperatively and electrophysiology was consulted. she converted to sinus rhythm subsequently. she was aggresively diuresed towards her preoperative weight. physical therapy worked with her for strength and mobility. on pod #6 she was cleared for discharge to in . appropriate follow up instructions, medications and appointments were given. medications on admission: ezetimibe-simvastatin 10 mg/40 mg tablet daily gentamicin - 0.1 % cream - apply twice daily hydrochlorothiazide 25 mg daily ketoconazole - 2 % cream - apply to rash daily levothyroxine 112 mcg daily lisinopril 40 mg daily triamcinolone acetonide 0.1 % cream - apply to ears and neck daily for 7 to 10 days tylenol extra strength 1000 mg calcium citrate-vitamin d3 dosage uncertain discharge disposition: extended care facility: - discharge diagnosis: aortic stenosis bicuspid aortic vaslve dilated ascending aorta s/p aortic valve replacement and ascending aortic replacement hypertension hypercholesterolemia s/p appendectomy h/o rheumatic fever osteoporosis s/p hysterectomy s/p ovarian cystectomy hypothyroidism s/p open reduction and internal fixation of right foot fracture 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 edema 1+ 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 call with any questions or concerns females: please wear bra to reduce pulling on incision, avoid rubbing on lower edge **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 mech avr (on-x)/ ascending aortic replacement (28 gelweave) goal inr 2.5-3.0 first draw results to phone - please arrange coumadin follow up on discharge from rehab followup instructions: you are scheduled for the following appointments: surgeon:dr. () on at 1:15pm cardiologist:dr. on at 12:oopm please call to schedule appointments with: primary care: dr. () in weeks labs: pt/inr for coumadin ?????? indication mech avr (on-x)/ ascending aortic replacement (28 gelweave) goal inr 2.5-3.0 first draw results to phone - please arraneg coumadin follow up on discharge from rehab **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** procedure: extracorporeal circulation auxiliary to open heart surgery open and other replacement of aortic valve resection of vessel with replacement, thoracic vessels other repair of heart and pericardium diagnoses: other iatrogenic hypotension pure hypercholesterolemia unspecified essential hypertension acute posthemorrhagic anemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified acquired hypothyroidism thoracic aneurysm without mention of rupture asthma, unspecified type, unspecified other chronic pulmonary heart diseases personal history of tobacco use osteoporosis, unspecified long-term (current) use of anticoagulants other diseases of lung, not elsewhere classified obesity, unspecified congenital insufficiency of aortic valve examination of participant in clinical trial rheumatic aortic stenosis body mass index 35.0-35.9, adult other second degree atrioventricular block personal history of allergy to penicillin other pulmonary insufficiency, not elsewhere classified, following trauma and surgery 

Answer: The patient is high likely exposed to