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: mitral regurgitation major surgical or invasive procedure: redo sternotomy,mitral valve repair (28mm medtroni futura ring) history of present illness: this 77 year old hispanic male with previous coronary artery bypass grafting underwent cardiac catheterization recently after he was noted on echocardiogram () that his mitral regurgitation was worsening. also of note the left atrial volume was severely increased, the right atrium was also markedly dilated and left ventricular function was 50-55%. cardiac surgery was consulted for surgical correction. past medical history: hypertension hyperlipidemia coronary artery disease mitral regurgitation h/o stroke- s/p tpa without residua chronic atrial flutter h/o gastrointestinal bleed gastroesophageal reflux disease s/p coronary artery bypass grafts s/p appendectomy social history: lives with:wife occupation:retired heavy equipment operator tobacco:quit 40 yrs ago etoh:denies family history: brother had cad in his 50's. he died at age 89 physical exam: admission: pulse: resp:14 o2 sat: b/p right: 102/50 left: 100/50 height: 64" weight:131# general: skin: dry intact heent: perrla eomi neck: supple full rom chest: lungs clear bilaterally heart: rrr irregular murmur2-3/6 sem abdomen: soft non-distended non-tender bowel sounds + extremities: warm , well-perfused edema varicosities: none sv harvest b thighs neuro: grossly intact pulses: femoral right:2 left:2 dp right: 2 left:2 pt : 2 left:2 radial right:2 left:2 carotid bruit right:n left:n pertinent results: 04:25am blood wbc-11.5* rbc-2.68* hgb-8.1* hct-24.1* mcv-90 mch-30.1 mchc-33.4 rdw-17.1* plt ct-90* 04:25am blood pt-14.5* inr(pt)-1.3* 09:15pm blood pt-14.1* ptt-31.5 inr(pt)-1.2* 09:15pm blood urean-24* creat-1.0 na-142 k-4.2 cl-103 hco3-31 angap-12 echocardiography report , (complete) done at 11:33:19 am final referring physician information , division of cardiothoracic , , r. , division of cardiothorac , status: inpatient dob: age (years): 77 m hgt (in): bp (mm hg): / wgt (lb): hr (bpm): bsa (m2): indication: abnormal ecg. congestive heart failure. coronary artery disease. h/o cardiac surgery. hypertension. mitral valve disease. pulmonary hypertension. icd-9 codes: 428.0, 786.05, 424.0 test information date/time: at 11:33 interpret md: , md test type: tee (complete) son: , md doppler: full doppler and color doppler test location: anesthesia west or cardiac contrast: none tech quality: adequate tape #: 2010aw5-: machine: echocardiographic measurements results measurements normal range left ventricle - ejection fraction: 50% to 55% >= 55% aorta - ascending: 3.1 cm <= 3.4 cm findings left atrium: moderate la enlargement. no spontaneous echo contrast is seen in the laa. no thrombus in the laa. right atrium/interatrial septum: normal ra size. pfo is present. left-to-right shunt across the interatrial septum at rest. left ventricle: normal lv wall thickness. top normal/borderline dilated lv cavity size. mildly depressed lvef. right ventricle: normal rv chamber size and free wall motion. aorta: normal aortic diameter at the sinus level. normal ascending aorta diameter. normal descending aorta diameter. complex (>4mm) atheroma in the descending thoracic aorta. aortic valve: three aortic valve leaflets. mildly thickened aortic valve leaflets (3). no as. trace ar. mitral valve: moderately thickened mitral valve leaflets. myxomatous mitral valve leaflets. no mass or vegetation on mitral valve. mild mitral annular calcification. torn mitral chordae. moderate to severe (3+) mr. to the eccentric mr jet, its severity may be underestimated (coanda effect). tricuspid valve: mild tr. pulmonic valve/pulmonary artery: normal pulmonic valve leaflet. no ps. physiologic pr. general comments: a tee was performed in the location listed above. i certify i was present in compliance with hcfa regulations. the patient was under general anesthesia throughout the procedure. the patient received antibiotic prophylaxis. the tee probe was passed with assistance from the anesthesioology staff using a laryngoscope. no tee related complications. patient. regional left ventricular wall motion: conclusions pre-cpb:1. the left atrium is moderately dilated. no spontaneous echo contrast is seen in the left atrial appendage. no thrombus is seen in the left atrial appendage. 2. a patent foramen ovale is present. a left-to-right shunt across the interatrial septum is seen at rest. 3. left ventricular wall thicknesses are normal. the left ventricular cavity size is top normal/borderline dilated. overall left ventricular systolic function is mildly depressed (lvef= 50 %). 4. right ventricular chamber size and free wall motion are normal. 5. there are complex (>4mm) atheroma in the descending thoracic aorta. 6. there are three aortic valve leaflets. the aortic valve leaflets (3) are mildly thickened. there is no aortic valve stenosis. trace aortic regurgitation is seen. 7. the mitral valve leaflets are moderately thickened. the mitral valve leaflets are myxomatous. no mass or vegetation is seen on the mitral valve. torn mitral chordae are present at p2. there is also leaflet retraction of the anterior leaflet, which is myxomatous. moderate to severe (3+) mitral regurgitation is seen. the mitral annulus is dilated and measures 3.9 cm. due to the eccentric nature of the regurgitant jet, its severity may be significantly underestimated (coanda effect). drs. and were notified in person of the results. post-cpb: on infusion of phenylephrine. av pacing. well-seated annuloplasty ring in the mitral position. no mr. t (mean of 1 mmhg). no pfo is seen. a web in the left atrium is visualized, and was confirmed by the surgeon at the time of surgery. preserved biventricular systolic function. aortic contour is normal post decannultion. i certify that i was present for this procedure in compliance with hcfa regulations. electronically signed by , md, interpreting physician 14:40 brief hospital course: mr. was admitted preoperatively for heparin bridge from coumadin. on he was brought to the operating room and underwent a redosternotomy-mitral valve repair. see operative report for further details. his ejection fraction post repair was 50-60%. he received cephazolin for perioperative antibiotics. he tolerated the procedure well and was transferred to the cvicu for further invasive monitoring. he was intubated and sedated on pressors to optimize cardiovascular function. medications were weaned off, he awoke neurologically intact and was extubated postoperatively without difficulty. all lines and drains were discontinued in a timely fashion. beta blockers/statin/asa/coumadin and diuresis were initiated. he continued to progress and on pod#1 he was transferred to the stepdown unit for further monitoring. physical therapy was consulted for evaluation of strength and mobility. coumadin was resumed for his chronic atrial flutter and pacing wires were removed. he developed transient elevation of bilirun to 5.4. lfts were otherwise unremarkable adn a right upper quadrant ultrasound demonstrated only some sludge in the gall bladder. bilirubin fell, he felt well and was tolerating a diet. bilirubin was down to 3.7 on . coumadin will be managed by his primary care physician (dr. ) with a pt/inr drawn on , along with a bilirubin. he was discharged to home with vna. all follow up appointments were advised. coumadin dosing will be 2.5mg on mg on then as directed by dr. . medications on admission: coumadin 5 mg daily lasix 40 mg daily imdur 30 mg daily lisinopril 20 mg daily lopressor 25 mg pantoprazole 40 mg daily simvastatin 20mg daily multivitamin daily iron daily discharge medications: 1. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed for fever or pain. 2. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 3. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po daily (daily) as needed for constipation. 4. simvastatin 20 mg tablet sig: one (1) tablet po at bedtime. disp:*30 tablet(s)* refills:*2* 5. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 6. outpatient lab work inr draw on and prn and call results to dr. phone: ; fax . total bilirubi on and call results to cardiac surgery at 7. coumadin 2.5 mg tablet sig: as directed for afib tablet po once a day: coumadin based on inr goal 2-2.5 with results called to dr. () . disp:*60 tablet(s)* refills:*2* 8. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain for 4 weeks. disp:*50 tablet(s)* refills:*0* 9. metoprolol tartrate 50 mg tablet sig: one (1) tablet po tid (3 times a day). disp:*90 tablet(s)* refills:*2* discharge disposition: home with service facility: community nurse care,inc discharge diagnosis: mitral regurgitation s/p redo sternotomy, mitral valve repair hypertension hyperlipidemia h/o cerebral vascular accident chronic atrial flutter h/o gastrointestinal bleed gastric esophageal reflux disease coronary artery disease s/p coronary artery bypass grafts 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 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 until follow up with surgeon 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 1:00 please call to schedule appointments with: primary care: dr in weeks () cardiologist dr in weeks **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** coumadin is for atrial flutter and will be managed by dr. and the first blood test is tio be drawn on***. the goal inr is 2-2.5. results to phone: fax: procedure: extracorporeal circulation auxiliary to open heart surgery open heart valvuloplasty of mitral valve without replacement diagnoses: esophageal reflux mitral valve disorders unspecified essential hypertension aortocoronary bypass status atrial flutter other and unspecified hyperlipidemia ostium secundum type atrial septal defect long-term (current) use of anticoagulants personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [ldh] rupture of chordae tendineae 

Answer: The patient is high likely exposed to