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: no known allergies / adverse drug reactions attending: chief complaint: exertional chest pressure and dyspnea major surgical or invasive procedure: aortic valve replacement with a . medical regent mechanical valve history of present illness: 46 year old gentleman with history of a functionally bicuspid aortic valve and aortic stenosis which has been followed by serial echocardiograms. his most recent echocardiogram revealed severe aortic stenosis and insufficiency. he denies any chest pain, dyspnea, orthopnea or palpitations. he has been referred for surgical evaluation for replacement of his aortic valve. past medical history: aortic stenosis/aortic insufficiency (bicuspid aortic valve) hypertension insulin-dependent diabetes mellitus ( wears dexcom continuous glucose monitor) r ankle nasal septal repair social history: lives with: wife in occupation: business owner tobacco:never etoh:occasional family history: father died after avr complications at age 67 physical exam: pulse:73 resp:16 o2 sat: 100% b/p right:121/77 left: 124/80 height: 73" weight:176 # general:nad, well-appearing skin: dry intact heent: perrla eomi anicteric sclera;op unremarkable neck: supple full rom no jvd appreciated chest: lungs clear bilaterally heart: rrr irregular murmur- 3/6 sem radiates throughout chest to carotids abdomen: soft non-distended non-tender bowel sounds + no hsm/cva tenderness; monitor probe subcut. llq extremities: warm , well-perfused edema-none varicosities: none neuro: grossly intact, nonfocal exam; mae strengths pulses: femoral right: 2+ left:2+ dp right: 1+ left:1+ pt : 1+ left:1+ radial right: 2+ left:2+ carotid bruit murmur radiates to b carotids pertinent results: 07:02am blood wbc-4.3 rbc-3.20* hgb-9.8* hct-28.8* mcv-90 mch-30.7 mchc-34.1 rdw-13.0 plt ct-163 03:23am blood wbc-8.5 rbc-3.24* hgb-10.0* hct-29.6* mcv-91 mch-30.9 mchc-33.9 rdw-13.2 plt ct-116* 05:12am blood wbc-7.8 rbc-3.27* hgb-9.9* hct-29.9* mcv-91 mch-30.4 mchc-33.3 rdw-13.3 plt ct-103* 07:02am blood pt-14.0* ptt-36.7* inr(pt)-1.3* 03:23am blood pt-11.2 inr(pt)-1.0 05:12am blood pt-12.1 inr(pt)-1.1 02:29am blood pt-11.5 ptt-28.2 inr(pt)-1.1 07:02am blood glucose-181* urean-13 creat-0.7 na-140 k-4.5 cl-101 hco3-33* angap-11 03:23am blood glucose-134* urean-12 creat-0.8 na-138 k-3.8 cl-99 hco3-32 angap-11 04:24pm blood na-139 k-4.3 cl-100 05:45am blood wbc-5.8 rbc-3.04* hgb-9.3* hct-27.0* mcv-89 mch-30.7 mchc-34.4 rdw-13.1 plt ct-242 05:45am blood pt-27.9* inr(pt)-2.7* 05:45am blood glucose-112* urean-21* creat-0.8 na-136 k-4.5 cl-101 hco3-27 angap-13 06:05am blood alt-13 ast-13 ld(ldh)-138 alkphos-56 amylase-42 totbili-0.2 06:05am blood albumin-3.8 mg-2.1 tte pre-bypass: no spontaneous echo contrast is seen in the body of the left atrium or left atrial appendage. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thicknesses are normal. the left ventricular cavity is mildly dilated. regional left ventricular wall motion is normal. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic valve is bicuspid. the aortic valve leaflets are severely thickened/deformed. there is moderate aortic valve stenosis (valve area 1.0-1.5 cm2). moderate to severe (3+) aortic regurgitation is seen. there is a large calcification restricting the a2 portion of the anterior leaflet of the mitral valve. no mitral regurgitation is seen. there is no mitral stenosis. there is a trivial pericardial effusion. post-bypass: the patient is in sinus rhythm. the patient is on no inotropes. image quality is suboptimal, with difficulty obtaining mid esophageal views. biventricular function is unchanged. there is a well-seated, well-functioning mechanical prosthetic valve in the aortic position. no paravalvular leak is seen. characteristic washing jets are seen. there is a mean gradient of 12 mmhg across the aortic valve at a cardiac output of 6.4 l/min. no mitral regurgitation is seen. the calcification on the anterior mitral leaflet is no longer present. the aorta is intact post-decannulation. cxr findings: pa and lateral views of the chest. there are small bilateral pleural effusions, right greater than left, which have decreased in size compared to most recent study. lungs are clear. there is no evidence of pneumonia. the cardiac, mediastinal and hilar contours are normal. median sternotomy wires are in appropriate position. there is no pulmonary vascular congestion. no pneumothorax. ekg sinus rhythm. left axis deviation. right bundle-branch block with left anterior fascicular block. there are tiny r waves in the inferior leads consistent with possible myocardial infarction. compared to the previous tracing of inferior r waves are smaller. intervals axes rate pr qrs qt/qtc p qrs t 73 174 124 408/430 -4 -49 23 brief hospital course: admitted same day surgery and was brought to the operating room for aortic valve replacement. see operative report for further details. in the first twenty four hours he weaned from sedation, awoke neurologically intact, and was extubated without complications. he remained in the intensive care unit for glucose management. he was started on betablockers, diuretics for gentle diuresis, and coumadin for mechanical aortic valve. chest tubes and epicardial wires were removed without complications and he continued to progress. physical therapy worked with him on strength and mobility. on post operative day three he was started on heparin to bridge until therapuetic with coumadin, and transferred to the floor for the remainder of his care. he continued to do well and was ready for discharge home with services on post operative day seven. medications on admission: multivitamin keflex 2g 1 hour prior to dental work lantus 18 units qhs novolog insulin sliding scale discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*1* 2. percocet 5-325 mg tablet sig: 1-2 tablets po every four (4) hours. 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). disp:*30 tablet, delayed release (e.c.)(s)* refills:*1* 4. ranitidine hcl 150 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*1* 5. warfarin 5 mg tablet sig: goal inr 2.5-3 tablets po once a day: dose to be adjusted based on inr goal 2.5-3, of note has taken 4-10mg . disp:*100 tablet(s)* refills:*2* 6. warfarin 2 mg tablet sig: goal inr 2.5-3 tablets po once a day: dose to be adjusted based on inr goal 2.5-3, of note has taken 4-10mg . . disp:*100 tablet(s)* refills:*2* 7. coumadin please take 7.5 mg on friday, saturday and sunday - then inr to be drawn monday for further dosing by dr please note that you have been given 5 mg and 2 mg tablets so that your dose can be adjusted 8. lantus 100 unit/ml solution sig: thirty (30) units subcutaneous at bedtime: you have been on 35 units in the hospital - please follow up with outpatient endocrinologist for adjustment further of lantus dosing . 9. insulin sliding scale please resume your novolg sliding scale for blood glucose coverage goal bg 100-120 10. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*1* 11. multivitamin tablet sig: one (1) tablet po once a day. 12. outpatient lab work labs: pt/inr for coumadin ?????? indication mechanical avr goal inr 2.5-3.0 first draw monday results to dr please call office with results for further dosing please draw monday, wednesday, and friday for the first two weeks then change as directed by cardiologist discharge disposition: home with service facility: discharge diagnosis: aortic stenosis/aortic insufficiency (bicuspid aortic valve) hypertension diabetes mellitus type 1 r ankle surgery nasal septal repair discharge condition: alert and oriented x3 nonfocal ambulating with steady gait incisional pain managed with percocet and tylenol incisions: sternal - healing well, no erythema or drainage edema none 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** please follow up with outpatient endocrinologist - you have been on a higher dose of lantus in the hospital followup instructions: you are scheduled for the following appointments medical building a cardiac surgery office wound check on 10:00 surgeon: dr at 1:15 pm cardiologist: dr. on at 2:00pm please call to schedule appointments with your 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 avr goal inr 2.5-3.0 first draw monday results to dr please call office with results for further dosing please draw monday, wednesday, and friday for the first two weeks then change as directed by cardiologist procedure: extracorporeal circulation auxiliary to open heart surgery open and other replacement of aortic valve diagnoses: thrombocytopenia, unspecified anemia, unspecified unspecified essential hypertension aortic valve disorders long-term (current) use of insulin long-term (current) use of anticoagulants congenital insufficiency of aortic valve diabetes mellitus without mention of complication, type i [juvenile type], not stated as uncontrolled examination of participant in clinical trial encounter for therapeutic drug monitoring 

Answer: The patient is high likely exposed to