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 and tricuspid regurgitation major surgical or invasive procedure: - redo sternotomy, mitral valve replacement(27mm st. mechanical), tricuspid valve repair(30mm ce annuloplasty ring) history of present illness: mrs. is a 57-year-old woman who is five years status post bovine pericardial aortic valve replacement who presents with increasing mitral regurgitation, tricuspid regurgitation and hepatic enlargement. it was elected to proceed with mitral valve replacement, tricuspid repair. past medical history: mitral regurgitation tricuspid regurgitation s/p aortic valve replacement systemic lupus erythematosis systemic hypertension pulmonary hypertension raynaud's disease s/p cholecystectomy lupus nephritis rheumatic heart disease portal hypertension anemia social history: patient is married with one son, denies tobacco, minimal etoh family history: grandmother died from a cva at age 50. father died at age 70 from complications of diabetes. physical exam: awake and alert lungs- clear cor-r at 70. crisp cardiac sounds, no murmur exts- 2- edema legs, not tense abdomen- soft, nontender, normoactive bowel sounds wounds- clean and dry. sternum is stable. pertinent results: echo pre bypass the left atrium is elongated. the right atrium is moderately dilated. no atrial septal defect is seen by 2d or color doppler. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the ascending, transverse and descending thoracic aorta are normal in diameter. there are simple atheroma in the descending thoracic aorta. a bioprosthetic aortic valve prosthesis is present. there is mild aortic valve stenosis (area 1.2-1.9cm2). mild (1+) aortic regurgitation is seen. there is mild valvular mitral stenosis (area 1.5-2.0cm2). moderate to severe (3+) mitral regurgitation is seen. severe tricuspid regurgitation is seen. there is no pericardial effusion. post bypass the patient is av-paced and on an infusion of epinephrine .04 mcg/kg/min.. left and right ventricular function is preserved. the aorta is intact. there is + tricuspid regurgitation. the mean gradient of the tricuspid valve was < 5mmhg. the mitral valve mechanical prosthesis is in good position with a mean gradient <6mmhg.. there is a mild mitral perivalvular leak. remaining exam is unchanged. these findings were communicated intraoperatively to dr. . 05:30am blood wbc-14.1* rbc-2.77* hgb-8.5* hct-25.4* mcv-92 mch-30.8 mchc-33.5 rdw-16.4* plt ct-283 10:50am blood pt-24.7* inr(pt)-2.4* 05:25am blood pt-40.7* ptt-36.2* inr(pt)-4.4* 01:35am blood pt-38.1* ptt-35.9* inr(pt)-4.1* 07:00pm blood pt-60.6* ptt-35.9* inr(pt)-7.2* 04:58pm blood pt-57.5* ptt-33.6 inr(pt)-6.8* 01:00pm blood pt-49.3* ptt-35.9* inr(pt)-5.6* 06:35am blood pt-45.7* ptt-81.8* inr(pt)-5.1* 10:04am blood pt-20.1* ptt-55.1* inr(pt)-1.9* 03:45am blood pt-17.1* ptt-56.5* inr(pt)-1.5* 05:50am blood pt-16.9* ptt-50.2* inr(pt)-1.5* 04:33am blood pt-17.7* ptt-38.3* inr(pt)-1.6* 03:08am blood pt-18.7* ptt-104.1* inr(pt)-1.7* brief hospital course: mrs. was admitted to the on for elective surgical management of her mitral and triccuspid valve disease. she was taken directly to the operating room where she underwent a redo sternotomy with a mitral valve replacement using a 27mm st. mechanical valve and a tricuspid valve repair/annuloplasty. please see operative note for details. postoperatively she was taken to the intensive care unit for monitoring. she weaned fro bypass on epinephrine and propafol. she was av paced due to underlying complete heart block.within 24 hours she awoke neurologically intact and was extubated. the pressor was weaned,however, she remained in heart block with a ventricular rate in the 30s. on pod 3 she was in sinus rhythm with first degree block in the 50s and stable. she was transferred to the floor. diuresis was continued, to remove fluid overload that existed preoperatively as well as secondary to the surgery. she developed atrial flutter subsequently. the eps service saw her and cardioversion was planned. on pod6 her inr was greater than 6 and 2 units of ffp were administered, with a fall of the inr to 4. the following day her inr was 3.1 and she received 1mg of coumadin. cardioversion with 200jouoles successfully converted her to sr which persisted at discharge. her inr was 2.4 the day of discharge and 2 mg of coumadin was ordered. her weight fell with diuresis and edema improved. she remained stable and felt well. she was ready for discharge and diuretics will be continued. arrangement were made for her follow-up for coumadin dosing with her primary care physician . . she will take 2mg and 16 then have a pt/inr checked on and talk with dr. for further orders. she is to return in 2 weeks for staple removal. medications on admission: lasix 20', plaquenil 200", lisinopril 40', lopressor 100", diovan 160', asa 81', ferrex 150", mvi discharge medications: 1. potassium chloride 20 meq tab sust.rel. particle/crystal sig: one (1) tab sust.rel. particle/crystal po twice a day. disp:*60 tab sust.rel. particle/crystal(s)* refills:*2* 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) for 2 weeks. disp:*28 capsule(s)* refills:*0* 3. ranitidine hcl 150 mg tablet sig: one (1) tablet po bid (2 times a day) for 2 weeks. disp:*28 tablet(s)* refills:*0* 4. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 5. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed. 6. hydroxychloroquine 200 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 7. multivitamin tablet sig: one (1) tablet po daily (daily). 8. polysaccharide iron complex 150 mg capsule sig: one (1) capsule po bid (). disp:*60 capsule(s)* refills:*2* 9. tramadol 50 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. disp:*50 tablet(s)* refills:*1* 10. percocet 5-325 mg tablet sig: 1-2 tablets po every four (4) hours as needed for pain for 4 weeks. disp:*50 tablet(s)* refills:*0* 11. warfarin 1 mg tablet sig: as directed tablet po once daily at 4 pm: md for instructions as directed. disp:*100 tablet(s)* refills:*2* 12. lorazepam 0.5 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. disp:*30 tablet(s)* refills:*0* 13. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 14. furosemide 40 mg tablet sig: one (1) tablet po twice a day. disp:*60 tablet(s)* refills:*2* discharge disposition: home with service facility: homecare discharge diagnosis: s/p mitral valve replacement and tricuspid annuloplasty mitral regurgitation tricuspid regurgitation s/p aortic valve replacement hypertention pulmonary hypertension systemic lupus erythematosis h/o rheumatic heart disease raynaud's disease congestive heart failure rheumatoid arthritis esophagheal spasm lupus nephritis anemia mild hepatic portal fibrosis s/p cholecystectomy discharge condition: good discharge instructions: 1) monitor wounds for signs of infection. these include redness, drainage or increased pain. in the event that you have drainage from your sternal wound, please contact the at (. 2) report any fever greater then 100.5. 3) report any weight gain of 2 pounds in 24 hours or 5 pounds in 1 week. 4) no lotions, creams or powders to incision until it has healed. you may shower and wash incision. gently pat the wound dry. please shower daily. no bathing or swimming for 1 month. 5) no lifting greater then 10 pounds for 10 weeks. 6) no driving for 1 month or while taking narcotics for pain. 7) call with any questions or concerns. followup instructions: please follow-up with dr. in 1 month. ( scheduled appointments: provider: , m.d. phone: date/time: 4:45 provider: , md phone: date/time: 2:30 provider: , md phone: date/time: 3:30 dr. in weeks and for coumadin dosing. procedure: extracorporeal circulation auxiliary to open heart surgery other electric countershock of heart open and other replacement of mitral valve annuloplasty transfusion of other serum diagnoses: chronic glomerulonephritis in diseases classified elsewhere systemic lupus erythematosus abnormal coagulation profile acute posthemorrhagic anemia portal hypertension cardiac complications, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified other chronic pulmonary heart diseases atrial flutter chronic kidney disease, unspecified rheumatic heart failure (congestive) atrioventricular block, complete surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation anticoagulants causing adverse effects in therapeutic use heart valve replaced by transplant diseases of tricuspid valve raynaud's syndrome rheumatic mitral insufficiency 

Answer: The patient is high likely exposed to