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: sulfa (sulfonamides) attending: chief complaint: dyspnea on exertion major surgical or invasive procedure: aortic valve replacement(25mm mosaic porcine valve), mitral valve replacement(29mm mosaic porcine valve), replacement of ascending aorta(26mm gelweave) and atrial myxoma removal history of present illness: mr. is an 81 year old male with known atrial fibrillation and atrial myxoma for approximately 9 years. serial echocardiograms have revealed worsening aortic insufficiency and mitral regurgitation. he concomitantly has complained of progressive dyspnea on exertion, pillow orthopnea and worsening cough. cardiac catheterization in showed normal coronary arteries and an lvef of 50%. a transesophogeal echocardiogram in confirmed 3+ ai, 3+mr, with a 3x3 centimeter right atrial mass. lvef was estimated at 65%. in preperation for cardiac surgery, he also underwent chest ct scan which revealed a dilated ascending aorta. after extensive preoperative evaluation, he was admitted for cardiac surgical intervention. past medical history: congestive heart failure(diastolic), aortic insufficiency, mitral regurgitation, atrial myxoma, dilated ascending aorta, atrial fibrillation, hypertension, hyperlipidemia, benign prostatic hypertrophy, sleep apnea - on cpap, obesity social history: retired, lives with wife in . quit cigars over 10 years ago. admits to social etoh consumption. family history: denies premature coronary disease(before age 55) physical exam: admission vitals: bp 140/90, hr 90, rr 14, sat 94% on room air general: well developed elderly male in no acute distress heent: oropharynx benign, voice hoarse neck: supple, no jvd, transmitted murmurs over carotid regions heart: irregular rate, normal s1s2, mixed diastolic and systolic murmurs lungs: clear bilaterally abdomen: soft, nontender, normoactive bowel sounds, mild hepatomegaly ext: warm, 2+ edema, no varicosities pulses: 2+ distally neuro: nonfocal discharge gen nad neuro a&ox3, nonfocal exam pulm decreased bases, otherwise clear cv rrr s1-s2. sternum stable, incision w/steris cdi abdm soft, nt/nd/+bs ext warm + pedal edema-bilat pertinent results: 04:42pm urea n-17 creat-0.7 chloride-112* total co2-25 04:42pm wbc-12.3* rbc-3.55* hgb-11.2* hct-31.0* mcv-87 mch-31.5 mchc-36.1* rdw-14.5 04:42pm plt count-141* 04:42pm pt-14.0* ptt-56.5* inr(pt)-1.2* 06:05am blood wbc-7.2 rbc-3.24* hgb-10.1* hct-30.3* mcv-94 mch-31.1 mchc-33.2 rdw-14.6 plt ct-337# 06:38am blood pt-14.2* inr(pt)-1.3* 06:05am blood plt ct-337# 05:25am blood glucose-115* urean-26* creat-1.0 na-143 k-3.3 cl-102 hco3-34* angap-10 chest (pa & lat) 11:00 am chest (pa & lat) reason: post op evaluation, sob medical condition: 82 year old man with avr/mvr/ascaorta replacement and ct removal reason for this examination: post op evaluation, sob two-view chest x-ray, . comparison: . cardiology report echo study date of patient/test information: indication: intraop avr, mvr, ascending aorta replacement. evaluate aorta, valves, binventricular function height: (in) 65 weight (lb): 206 bsa (m2): 2.01 m2 bp (mm hg): 165/85 hr (bpm): 80 status: inpatient date/time: at 13:20 test: tee (complete) doppler: full doppler and color doppler contrast: none tape number: 2007aw1-: test location: anesthesia west or cardiac technical quality: adequate referring doctor: dr. measurements: left atrium - long axis dimension: *7.5 cm (nl <= 4.0 cm) left atrium - four chamber length: *5.7 cm (nl <= 5.2 cm) left ventricle - inferolateral thickness: *1.4 cm (nl 0.6 - 1.1 cm) left ventricle - diastolic dimension: 5.6 cm (nl <= 5.6 cm) left ventricle - systolic dimension: 4.8 cm left ventricle - fractional shortening: *0.14 (nl >= 0.29) left ventricle - ejection fraction: 50% to 55% (nl >=55%) aorta - valve level: *4.1 cm (nl <= 3.6 cm) aorta - ascending: *4.5 cm (nl <= 3.4 cm) aorta - arch: *3.6 cm (nl <= 3.0 cm) aorta - descending thoracic: *3.8 cm (nl <= 2.5 cm) aortic valve - peak velocity: 1.5 m/sec (nl <= 2.0 m/sec) aortic valve - peak gradient: 9 mm hg aortic valve - mean gradient: 4 mm hg aortic valve - valve area: 3.7 cm2 (nl >= 3.0 cm2) mitral valve - mva (2d): 4.9 cm2 pulmonary artery - main diameter: *3.5 cm pericardium - effusion size: 0.5 cm interpretation: findings: left atrium: marked la enlargement. elongated la. no mass/thrombus in the laa. mild spontaneous echo contrast in the laa. no thrombus in the laa. right atrium/interatrial septum: mildly dilated ra. left ventricle: wall thickness and cavity dimensions were obtained from 2d images. mild symmetric lvh. top normal/borderline dilated lv cavity size. low normal lvef. lv wall motion: regional lv wall motion abnormalities include: mid inferolateral - hypo; remaining lv segments contract normally. right ventricle: moderately dilated rv cavity. aorta: moderately dilated aortic sinus. moderately dilated ascending aorta. mildly dilated aortic arch. simple atheroma in aortic arch. moderately dilated descending aorta complex (>4mm) atheroma in the descending thoracic aorta. aortic valve: normal aortic valve leaflets (3). no as. moderate to severe (3+)ar. eccentric ar jet. mitral valve: mildly thickened mitral valve leaflets. moderate to severe (3+) mr. tricuspid valve: normal tricuspid valve leaflets. mild tr. pulmonic valve/pulmonary artery: normal pulmonic valve leaflets. no pr. pericardium: small pericardial effusion. general comments: a tee was performed in the location listed above. i certify i was present in compliance with hcfa regulations. no tee related complications. the patient was under general anesthesia throughout the procedure. conclusions: pre bypass: the left atrium is markedly dilated. the left atrium is elongated. no mass/thrombus is seen in the left atrium or left atrial appendage. mild spontaneous echo contrast is present in the left atrial appendage. no thrombus is seen in the left atrial appendage. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is top normal/borderline dilated. overall left ventricular systolic function is low normal (lvef 50-55%). the remaining left ventricular segments contract normally. the right ventricular cavity is moderately dilated. the aortic root is moderately dilated athe sinus level. the ascending aorta is moderately dilated. the aortic arch is mildly dilated. there are simple atheroma in the aortic arch. the descending thoracic aorta is moderately dilated. there are complex (>4mm) atheroma in the descending thoracic aorta. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion. there is no aortic valve stenosis. moderate to severe (3+) aortic regurgitation is seen. the aortic regurgitation jet is eccentric. the mitral valve leaflets are mildly thickened. moderate to severe (3+) mitral regurgitation is seen. there is a right atrial mass just above the svc inlet. it is rounded and almost reaches the interatrial septum. there is a small pericardial effusion. post bypass: perserved biventricular function, lvef >55%. an aortic bioprostesis is insitu. no ai or as, no perivalvular leaks. a mitral bioprosthesis is insitu, no mr, no ms, no perivalvular leaks. an prosthetic graft is seen in the proximal ascending aorta above the sinus of valsalva. the remaing aortic contours are intact. there is no longer a right atrial masss or pericardial effusion. the remainder of the exam is unchanged. all findings are discussed with surgeons at the time of the exam. electronically signed by , md on 15:54. cxr indication: shortness of breath. right internal jugular vascular sheath has been removed with no pneumothorax. lung volumes remain low, and cardiac and mediastinal contours are stable in appearance. bibasilar atelectasis and small pleural effusions are again demonstrated. impression: persistent bibasilar atelectasis and small pleural effusions. dr. brief hospital course: mr. was admitted and underwent aortic and mitral valve replacments, along with replacement of ascending aorta and excision of atrial myxoma. for surgical details, please see seperate dictated operative note. following the operation, he was brought to the csru for invasive monitoring. within 24 hours, he awoke neurologically intact and was extubated without incident. he maintained stable hemodynamics and weaned from inotropic support. on postoperative day two, he experienced oliguria with rise in creatinine. volume and intravenous fluids were administered while diuretics and beta-blockers were initially withheld. he was started on neosynephrine to maintain maps > 70 mmhg and renal perfusion. his creatinine peaked to 1.7 on postoperative day two. over several days, his urine output and renal function improved. neosynephrine was gradually weaned without difficulty. diuretics and beta blockade were gradually resumed. on postoperative day four, he transferred to the sdu for further care and recovery. despite remaining in a normal sinus rhythm(with first degree av block)postoperatively, warfarin anticoagulation was eventually resumed given his history of atrial fibrillation and myxoma resection. he continued to make clinical improvements with diuresis and was eventually cleared for discharge to home on postoperative day 9. his inr was to be followed by dr until his return to . medications on admission: flonase k-dur 60 meq proscar 5 qd lasix 40 qam detrol la 4 qam procardia 30 qpm fexofenadine 180 qpm hytrin 10 qd benicar 40 qpm lipitor 20 qd toprol xl 20 qd singulair 10 qd warfarin 6mg qd - stopped 5 days prior to admission discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 2. atorvastatin 20 mg tablet sig: one (1) tablet po daily (daily). 3. tamsulosin 0.4 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po hs (at bedtime). 4. finasteride 5 mg tablet sig: one (1) tablet po daily (daily). 5. fexofenadine 60 mg tablet sig: three (3) tablet po daily (daily). 6. montelukast 10 mg tablet sig: one (1) tablet po daily (daily). 7. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 8. ranitidine hcl 150 mg tablet sig: one (1) tablet po bid (2 times a day). 9. alprazolam 0.25 mg tablet sig: one (1) tablet po tid (3 times a day) as needed. disp:*20 tablet(s)* refills:*0* 10. outpatient lab work please check inr friday . send result to dr. office at f(. discharge disposition: home with service facility: vna discharge diagnosis: congestive heart failure(diastolic), aortic insufficiency, mitral regurgitation, atrial myxoma, dilated ascending aorta - s/p aortic valve replacement, mitral valve replacement, replacement of ascending aorta and atrial myxoma removal, postop acute renal insufficiency, atrial fibrillation, hypertension, hyperlipidemia, benign prostatic hypertrophy, sleep apnea - on cpap discharge condition: good discharge instructions: patient may shower, no baths. no creams, lotions or ointments to incisions. no driving for at least one month. no lifting more than 10 lbs for at least 10 weeks from the date of surgery. monitor wounds for signs of infection. please call with any concerns or questions. followup instructions: dr. in weeks, call for appt dr. in weeks, call for appt dr. , call for appt procedure: extracorporeal circulation auxiliary to open heart surgery diagnostic ultrasound of heart non-invasive mechanical ventilation excision or destruction of other lesion or tissue of heart, open approach open and other replacement of aortic valve with tissue graft resection of vessel with replacement, thoracic vessels open and other replacement of mitral valve with tissue graft diagnoses: obstructive sleep apnea (adult)(pediatric) acute kidney failure with lesion of tubular necrosis unspecified essential hypertension thoracic aneurysm without mention of rupture atrial fibrillation mitral valve insufficiency and aortic valve insufficiency hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) rheumatic heart failure (congestive) long-term (current) use of anticoagulants benign neoplasm of heart 

Answer: The patient is high likely exposed to