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: patient recorded as having no known allergies to drugs attending: chief complaint: progressive dyspnea on exertion major surgical or invasive procedure: aortic valve replacement (#21mm st. mechanical)/mitral valve replacement (#29mm st. mechanical)- history of present illness: 58 year-old gentleman who has had progressive dyspnea on exertion. he also had a prior history of aortic stenosis and underwent cardiac catheterization in which showed no significant coronary artery disease with severe aortic stenosis and mitral regurgitation. echocardiogram performed on showed posterior mitral valve leaflet prolapse with moderate-to-severe mr, severe aortic stenosis with aortic valve area of 0.6 cm2 (peak gradient of 39 mm and mean gradient of 22 mm), and ejection fraction of 55%.dr. was consulted for surgical intervention and valvular replacement. past medical history: metabolic syndrome, hypertension, non-insulin-dependent diabetes mellitus, mitral regurgitation, aortic stenosis, aortic insufficiency, obstructive sleep apnea, chronic obstructive pulmonary disease, and pulmonary hypertension. social history: he works as a contractor. his last dental examination was two months ago. he denies using tobacco currently but has used it occasionally in the past. however, he does have significant alcohol problem as he admits to six to nine beers per day...patient states he was quit drinking etoh over the last month. family history: his father had coronary artery bypass surgery in his 50s and died in his early 60s. a strong family history is also present of diabetes. physical exam: on exam, his heart rate is 73, respiratory rate 16, and blood pressure of 103/74. he is well developed and well nourished in no apparent distress. skin was unremarkable and intact. his eoms were intact. his pupils were equally round and reactive to light and accommodation. neck was supple with full range of motion and no jvd or carotid bruitswere appreciated. lungs were clear bilaterally. heart revealsa regular rate and rhythm with a grade ii/vi holosystolic murmur. abdomen was soft, nontender, and nondistended with positive bowel sounds. extremities were warm and well perfused without any edema or varicosities. he was alert and oriented x3. he is moving all extremities and had a nonfocal neurologic exam. he had 2+ bilateral femoral dp, pt, and radial pulses. pertinent results: 05:10am blood pt-24.3* ptt-87.7* inr(pt)-2.3* 05:30am blood pt-24.8* ptt-63.7* inr(pt)-2.4* 06:10am blood pt-20.4* ptt-64.6* inr(pt)-1.9* 06:05am blood pt-19.0* ptt-58.9* inr(pt)-1.7* 08:55am blood pt-19.9* ptt-77.4* inr(pt)-1.8* 05:46pm blood wbc-7.7 rbc-3.02*# hgb-8.6*# hct-25.1*# mcv-83 mch-28.4 mchc-34.2 rdw-13.6 plt ct-120* 05:46pm blood pt-15.0* ptt-33.2 inr(pt)-1.3* 02:11am blood calcium-8.1* phos-2.3* mg-2.2 echocardiography report done at 2:30:00 pm final referring physician information , r. , division of cardiothorac , status: inpatient dob: age (years): 58 m hgt (in): 68 bp (mm hg): 119/81 wgt (lb): 205 hr (bpm): 75 bsa (m2): 2.07 m2 indication: h/o cardiac surgery with 21mm avr, and mvr. icd-9 codes: v43.3, 424.1, 424.0 test information date/time: at 14:30 interpret md: , md test type: portable tte (complete) son: , rdcs doppler: full doppler and color doppler test location: / 6 contrast: none tech quality: suboptimal tape #: 2009w051-0:18 machine: vivid echocardiographic measurements results measurements normal range left ventricle - ejection fraction: >= 60% >= 55% aortic valve - peak velocity: *2.8 m/sec <= 2.0 m/sec aortic valve - peak gradient: *30 mm hg < 20 mm hg aortic valve - mean gradient: 15 mm hg mitral valve - peak velocity: 1.6 m/sec mitral valve - mean gradient: 5 mm hg mitral valve - e wave: 1.6 m/sec mitral valve - a wave: 1.1 m/sec mitral valve - e/a ratio: 1.45 mitral valve - e wave deceleration time: 209 ms 140-250 ms tr gradient (+ ra = pasp): *30 mm hg <= 25 mm hg findings left ventricle: suboptimal technical quality, a focal lv wall motion abnormality cannot be fully excluded. low normal lvef. no resting lvot gradient. right ventricle: normal rv chamber size and free wall motion. paradoxic septal motion consistent with prior cardiac surgery. aortic valve: bileaflet aortic valve prosthesis (avr). normal avr gradient. no ar. mitral valve: bileaflet mitral valve prosthesis (mvr). normal mvr gradient. trivial mr. tricuspid valve: normal tricuspid valve leaflets. mild tr. mild pa systolic hypertension. pulmonic valve/pulmonary artery: pulmonic valve not well seen. pericardium: no pericardial effusion. general comments: suboptimal image quality - poor parasternal views. suboptimal image quality - bandages, defibrillator pads or electrodes. conclusions due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is low normal (lvef 50-55%). right ventricular chamber size and free wall motion are normal. a bileaflet aortic valve prosthesis is present and appears well-seated. the transaortic gradient is normal for this prosthesis. no aortic regurgitation is seen. a bileaflet mitral valve prosthesis is present and appears well-seated. the transmitral gradient is normal for this prosthesis. trivial mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. electronically signed by , md, interpreting physician 17:33 brief hospital course: mr. went to the operating room and underwent aortic valve replacement (#21mm st. mechanical)/mitral valve replacement (#29mm st. mechanical).cross clamp time=126 minutes. cardiopulmonary bypass time=148 minutes. please refer to dr operative report for further details. he tolerated the procedure well and was transferred to the cvicu in critical but stable condition, requiring pressors and inotrope to optimize cardiac output. he awoke neurologically intact and was extubated without difficulty. all drips were weaned to off. beta-blocker was initially held off due to a first degree av block. anticoagulation was started with coumadin, and bridged with a heparin drip for therapeutic inr with mechanical valves. was consulted for glucose control. low dose beta-blocker was ultimately started due to his increased heart rate. his rate blocked down, beta-blocker discontinued , and electrophysiology was consulted. pod#9 ppm was placed secondary to heart block. ep interrogated the ppm and continued to follow. the remainder of his postoperative course was essentially uneventful. discharge was dependent upon therapeutic inr. on pod# 17/8 mr. was cleared by dr. for discharge to home with vna. all follow up appointments were advised. coumadin/inr to be followed by his pcp, . . medications on admission: quinaretic 20/25 mg daily, cartia xt 180 mg daily, cozaar 100 mg daily, simvastatin 80 mg daily, tricor 48 mg daily, aspirin 325 mg daily, glucotrol 5 mg daily, metformin 500 mg q.a.m. and 1000 mg q.p.m., lasix 40 mg daily, albuterol inhalers, and flovent inhalers two puffs twice a day. discharge medications: 1. outpatient lab work dr. will follow inr (confirmed with in office) (p) , (f) . vna to fax results to office for titration. 2. zocor 80 mg tablet sig: one (1) tablet po at bedtime. disp:*30 tablet(s)* refills:*0* 3. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). tablet, delayed release (e.c.)(s) 4. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 5. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 6. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 7. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. disp:*50 tablet(s)* refills:*0* 8. fenofibrate micronized 48 mg tablet sig: one (1) tablet po daily () as needed for hyperlipidemia. disp:*30 tablet(s)* refills:*0* 9. glipizide 5 mg tablet sig: two (2) tablet po bid (2 times a day). disp:*120 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. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*0* 12. warfarin 2.5 mg tablet sig: as directed tablet po once a day: please take 7.5 mg daily. inr will be checked monday by vna and your doctor will call you with dose changes as needed. disp:*90 tablet(s)* refills:*0* 13. warfarin 1 mg tablet sig: as directed tablet po once a day: please take 7.5 mg daily. inr will be checked monday by vna and your doctor will call you with dose changes as needed. disp:*50 tablet(s)* refills:*0* 14. insulin glargine 100 unit/ml solution sig: 15 units subcutaneous at bedtime. disp:*qs qs* refills:*0* 15. insulin lispro 100 unit/ml solution sig: as directed subcutaneous every six (6) hours: see discharge instructions for scale. disp:*qs qs* refills:*0* discharge disposition: home with service facility: discharge diagnosis: mitral regurgitation aortic stenosis s/p avr, mvr this admission discharge condition: good discharge instructions: please shower daily including washing incisions, no baths or swimming monitor wounds for infection - redness, drainage, or increased pain report any fever greater than 101 report any weight gain of greater than 2 pounds in 24 hours or 5 pounds in a week no creams, lotions, powders, or ointments to incisions no driving for approximately one month no lifting more than 10 pounds for 10 weeks please call with any questions or concerns followup instructions: dr. in 4 weeks () please call for appointment dr. , h. -in 1 week please call for appointment dr. will follow inr, confirmed with vna to draw pt/inr mon. and call results to dr. wound check appointment 6 as instructed by nurse ( procedure: extracorporeal circulation auxiliary to open heart surgery catheter based invasive electrophysiologic testing initial insertion of dual-chamber device initial insertion of transvenous leads [electrodes] into atrium and ventricle open and other replacement of aortic valve open and other replacement of mitral valve diagnoses: congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled cardiac complications, not elsewhere classified other chronic pulmonary heart diseases atrioventricular block, complete mitral valve insufficiency and aortic valve stenosis surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation chronic obstructive asthma, unspecified accidents occurring in residential institution dysmetabolic syndrome x other premature beats paroxysmal tachycardia, unspecified 

Answer: The patient is high likely exposed to