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: pollen attending: chief complaint: increasing exertional dyspnea and fatigue major surgical or invasive procedure: aortic valve replacement ( regent mechanical) history of present illness: this 55 year old gentleman with a history of a patent ductus arteriosus repair as a child and a known bicuspid aortic valve which has been followed by serial echocardiograms over the past decade. serial echocardiograms have shown a progressive decrease in his aortic valve area and now a slightly depressed left ventricular function. he is symptomatic with dyspnea and chest heaviness with exertion as well as a generalized fatigue. given the progression of his disease and early decline in lv function, he has been referred for surgical management. past medical history: aortic valve stensosis/insufficiency hypertension hyperlipidemia gout anemia insulin dependent diabetes mellitus chronic kidney disease (creat 1.4) diabetic neuropathy gastroesophageal reflux s/p patent ductus arteriosus repair as child 8 y/o() s/p cataract surgery s/p tonsillectomy social history: lives with: wife in occupation: cook at univ. dining services tobacco: 40 pack year history quit etoh: drinks per day family history: mother died of mi at 84. sister with mi at 58. physical exam: pulse: 84 sr resp: 18 o2 sat: 100% b/p right: 177/66 left: 170/65 height: 70" weight:182lb bsa: 2.01m2 general: wdwn in nad skin: warm, dry, intact. well healed left thoracotomy heent: perrla, eomi, sclera anicteric. teeth in poor repair. neck: supple full rom no jvd chest: lungs clear bilaterally ; well healed left thoracotomy extending very close to the sternum. heart: rrr, iii/vi systolic ejection murmur; abdomen: soft non-distended non-tender bowel sounds + extremities: warm , well-perfused no edema varicosities: none. neuro: grossly intact pulses: femoral right:2 left:2 dp right:1 left:1 pt :1 left:1 radial right:2 left:2 carotid bruit bilat: transmitted soft sound likely from the heart murmur vs bruit pertinent results: intraop tee: pre-cpb: the left atrium is moderately dilated. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is mildly depressed (lvef=40-45 %). right ventricular chamber size and free wall motion are normal. the ascending aorta is mildly dilated. there are simple atheroma in the descending thoracic aorta. no thoracic aortic dissection is seen. the aortic valve is bicuspid with a horizontal commisure. the aortic valve leaflets are moderately thickened. there is critical aortic valve stenosis (valve area <0.8cm2). moderate (2+) aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. trivial mitral regurgitation is seen. post-cpb: there is a mechanical valve in the aortic position. the valve is well-seated with normally mobile leaflets. there is no evidence of paravalvular leaks. the peak gradient across the aortic valve is 14mmhg, the mean gradient is 7mmhg with co of 5l/min. the lv systolic function remains mildly impaired, unchanged from pre-op, estimated ef=40-45%. there is no evidence of aortic dissection. . 11:00am blood hct-25.4* 05:45am blood wbc-5.9 rbc-2.66* hgb-8.7* hct-23.8* mcv-90 mch-32.9* mchc-36.8* rdw-13.5 plt ct-262 04:45am blood pt-29.1* ptt-34.1 inr(pt)-2.8* 01:15pm blood pt-34.5* inr(pt)-3.4* 05:45am blood pt-32.2* inr(pt)-3.2* 04:45am blood urean-34* creat-1.6* na-138 k-4.3 cl-102 04:45am blood mg-1.8 brief hospital course: mr. was admitted and underwent mechanical aortic valve replacement by dr. (see operative report for further details). he received cefazolin for perioperative antibiotics. following the operation, he was brought to the intensive care unit for invasive monitoring. within 24 hours, he awoke neurologically intact and was extubated without complication. on post operative day one he was started on beta blockers, lasix for gentle diuresis and transferred to the floor. warfarin was initiated and dosed for a goal inr between 2.5 - 3.0. he remained in a normal sinus rhythm without atrial or ventricular arrhythmias. beta blockade was advanced as tolerated and his preoperative labetolol was resumed. chest tubes and pacing wires removed per protocol.over several days, he continued to make clinical improvements with diuresis and was cleared for discharge to home on postoperative day # 5. at discharge, his inr was 3.2. prior to discharge, arrangements were made with the to monitor warfarin as an outpatient.first inr check tomorrow . medications on admission: allopurinol 100 mg daily amlodipine 5 mg daily atorvastatin 80 mg daily colchicine 0.6 mg daily enalapril maleate 5 mg daily furosemide 40 mg daily labetalol 300 mg qpm and 150 mg qam lorazepam 0.5 mg prn omeprazole 20 mg daily aspirin 81 mg daily ergocalciferol 1,000 unit capsule daily nph insulin 100 unit/ml suspension per sliding (3-7 units before dinner) omega-3 fatty acids 1,000 mg daily vitamin e 400 unit daily discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) for 1 months. disp:*60 capsule(s)* refills:*0* 2. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). disp:*30 tablet, delayed release (e.c.)(s)* refills:*1* 3. warfarin 1 mg tablet sig: four (4) tablet po daily (daily) for 1 days: 4 mg dose today only; then all further daily dosing per coumadin clinic provider at /; target inr 2.5-3.0 for mechanical aortic valve. disp:*100 tablet(s)* refills:*1* 4. 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* 5. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*1* 6. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). disp:*30 capsule, delayed release(e.c.)(s)* refills:*1* 7. multivitamin tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*1* 8. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*1* 9. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*1* 10. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*1* 11. labetalol 100 mg tablet sig: 1.5 tablets po qam (once a day (in the morning)): 150 mg every morning. disp:*100 tablet(s)* refills:*1* 12. labetalol 200 mg tablet sig: 1.5 tablets po qpm (once a day (in the evening)): 300 mg every evening. disp:*100 tablet(s)* refills:*1* 13. enalapril maleate 5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*1* 14. furosemide 40 mg tablet sig: one (1) tablet po daily (daily) for 1 weeks. disp:*7 tablet(s)* refills:*0* 15. potassium chloride 10 meq tablet extended release sig: two (2) tablet extended release po daily (daily) for 1 weeks. disp:*14 tablet extended release(s)* refills:*0* 16. nph insulin /humulin n sig: 3-7 units sliding scale injection every evening before dinner. disp:*20 100u/ml solutions* refills:*1* 17. outpatient lab work please draw bun/creatinine in one week with results to pcp discharge disposition: extended care facility: senior living discharge diagnosis: aortic valve stenosis/insufficiency s/p aortic valve replacement (mechanical) hypertension hyperlipidemia gout anemia insulin dependent diabetes mellitus chronic kidney disease diabetic neuropathy gastroesophageal reflux disease 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 **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 () on at 1:15pm cardiologist: dr on at 2:20pm please call to schedule appointments with: 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 sunday results to coumadin clinic phone procedure: extracorporeal circulation auxiliary to open heart surgery open and other replacement of aortic valve diagnoses: esophageal reflux hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes chronic kidney disease, unspecified congenital insufficiency of aortic valve personal history of surgery to heart and great vessels, presenting hazards to health congenital stenosis of aortic valve 

Answer: The patient is high likely exposed to