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, dental caries major surgical or invasive procedure: dental extractions mitral valve replacement (27mm st. mechanical),ligation of left atrial appendage history of present illness: this 49 year old white female has rheumatic heart disease. she has mixed mitral regurgitation and stenosis with normal pa pressures. her main complaint is dyspnea on exertion. she is admitted at this time for dental extractions, followed by mitral valve replacement. past medical history: mitral regurgitation mitral stenosis paroxsymal atrial fibrillation dental caries obesity rheumatic heart disease hypertension s/p pheochromcytoma resection s/p c-sections x4 social history: current smoker- 25 pack year history lives with her daughter works as a taxi dispatcher occasionla etoh use family history: noncontributory physical exam: admission: pulse: 89 sr resp: 18 o2 sat: 98% ra b/p right: 116/69 left: 110/60 height: 66 inches weight:265 pounds general: well appearing female in no apparent distress skin: dry intact heent: perrla eomi neck: supple full rom chest: lungs clear bilaterally heart: rrr irregular murmur abdomen: soft non-distended non-tender bowel sounds extremities: warm , well-perfused edema varicosities: none 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: none left:none pertinent results: 05:50am blood wbc-14.1* rbc-3.57* hgb-9.9* hct-30.0* mcv-84 mch-27.7 mchc-32.9 rdw-14.9 plt ct-235 12:50pm blood wbc-9.0 rbc-4.36 hgb-12.4 hct-36.6 mcv-84 mch-28.5 mchc-33.9 rdw-15.0 plt ct-440 05:50am blood pt-13.2 inr(pt)-1.1 12:50pm blood pt-13.5* inr(pt)-1.2* 05:50am blood glucose-131* urean-8 creat-0.6 na-135 k-4.1 cl-101 hco3-26 angap-12 12:50pm blood glucose-139* urean-14 creat-0.7 na-136 k-4.2 cl-103 hco3-24 angap-13 echocardiography report , (complete) done at 9:32:33 am final referring physician information , r. , division of cardiothorac , status: inpatient dob: age (years): 49 f hgt (in): bp (mm hg): / wgt (lb): hr (bpm): bsa (m2): indication: intraoperative tee for mitral valve replacement icd-9 codes: 427.31, 440.0, 394.2, 424.2 test information date/time: at 09:32 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: suboptimal tape #: 2009aw2-: machine: aw2 echocardiographic measurements results measurements normal range left atrium - long axis dimension: *7.3 cm <= 4.0 cm left atrium - four chamber length: *7.6 cm <= 5.2 cm left ventricle - inferolateral thickness: 0.9 cm 0.6 - 1.1 cm left ventricle - diastolic dimension: *5.9 cm <= 5.6 cm left ventricle - ejection fraction: 55% to 60% >= 55% aorta - ascending: 3.0 cm <= 3.4 cm aorta - descending thoracic: 2.1 cm <= 2.5 cm aortic valve - lvot diam: 1.8 cm mitral valve - peak velocity: 2.1 m/sec mitral valve - mean gradient: 7 mm hg mitral valve - pressure half time: 140 ms mitral valve - mva (p t): 1.6 cm2 findings left atrium: marked la enlargement. mild spontaneous echo contrast in the body of the la. no mass/thrombus in the laa. good (>20 cm/s) laa ejection velocity. all four pulmonary veins identified and enter the left atrium. right atrium/interatrial septum: dilated ra. a catheter or pacing wire is seen in the ra and extending into the rv. no asd by 2d or color doppler. prominent eustachian valve (normal variant). left ventricle: wall thickness and cavity dimensions were obtained from 2d images. normal lv wall thickness. mildly dilated lv cavity. suboptimal technical quality, a focal lv wall motion abnormality cannot be fully excluded. overall normal lvef (>55%). right ventricle: borderline normal rv systolic function. aorta: normal aortic diameter at the sinus level. normal ascending aorta diameter. normal aortic arch diameter. simple atheroma in aortic arch. normal descending aorta diameter. simple atheroma in descending aorta. aortic valve: mildly thickened aortic valve leaflets (3). no as. no ar. mitral valve: moderately thickened mitral valve leaflets. characteristic rheumatic deformity of the mitral valve leaflets with fused commissures and tethering of leaflet motion. mild mitral annular calcification. moderate valvular ms (mva 1.0-1.5cm2) moderate to severe (3+) mr. tricuspid valve: tricuspid valve not well visualized. mild to moderate +] tr. pulmonic valve/pulmonary artery: pulmonic valve not well seen. no pr. pericardium: no pericardial effusion. 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 tee probe was passed with assistance from the anesthesioology staff using a laryngoscope. no tee related complications. suboptimal image quality. the patient appears to be in sinus rhythm. results were personally reviewed with the md caring for the patient. conclusions pre-bypass: the left atrium is markedly dilated. mild spontaneous echo contrast is seen in the body of the left atrium. no mass/thrombus is seen in the left atrium or left atrial appendage. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thicknesses are normal. overall left ventricular systolic function is normal (lvef>55%). the right ventricle displays borderline normal free wall function. there are simple atheroma in the descending thoracic aorta. the aortic valve leaflets (3) appear mildly thickened with good leaflet excursion. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are moderately thickened/deformed. the mitral valve shows characteristic rheumatic deformity. there is moderate valvular mitral stenosis (area 1.6 cm2). moderate to severe (3+) mitral regurgitation is seen. there is no pericardial effusion. post-bypass: the patient is receiving no inotropic support post-cpb and is in sinus rhythm. there is a well-seated, bileaflet valvular prothesis in the mitral position. there is good leaflet excursion with a mean gradient of 6 mm hg in the setting of a cardiac output of 6.5 l/min. there is no paravalvular regurgitation. there is mild transvalvular regurgitation in expected positions consistent with washing jets. biventricular systolic function is preserved. all other findings are consistent with pre-bypass findings. the aorta is intact post-decannulation. all findings communicated to the surgeon, dr. , at the time of the study. i certify that i was present for this procedure in compliance with hcfa regulations. electronically signed by , md, interpreting physician 12:16 ?????? caregroup is. all rights reserved. brief hospital course: following admission routine labs, cxr and ecg were obtained. as has been arranged, she went to the operating room on where teeth 3-6,11,17,22 and 27 were extracted. she tolerated this well. on she returned to the operating room where mitral valve replacement with a mechanical valve (#27mm st. mechanical)was performed by dr.. cross clamp time= 68 minutes. cardiopulmonary bypass time=86 minutes.please refer to operative note for further surgical details. she was transferred intubated and sedated, in critical but stable condition. she awoke neurologically intact and was weaned from the ventilator and extubated the afternoon of surgery. all lines and drains were discontinued in a timely fashion. ace-i/sotalol/statin/asa, and diuresis was initiated. she continued to progress and was transferred to the step down unit on pod#1. anticoagulation with coumadin for paroxysmal atrial fibrillation and mechanical valve was resumed. heparin drip was initiated on pod#3 to bridge until her inr is therapeutic on coumadin. physical therapy was consulted for evaluation. the remainder of her postoperative course was essentially uncomplicated. she was cleared for discharge to home by dr. on pod# 8. inr=2.8. ms. was advised to resume coumadin follow up with dr. at heart center coumadin clinic. all follow up appointments were advised. medications on admission: sotalol 120 mg lisinopril 10 mg daily vit d 50,000 qweekly x 13 weeks coumadin 7.5 mg t-thurs, 10 mg m-w-f-s-sun. f/u w/ clinic heart center. clindamycin 600 mg started for dental work peridex mouth wash discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 2. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). disp:*60 tablet, delayed release (e.c.)(s)* refills:*2* 3. ranitidine hcl 150 mg tablet sig: one (1) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 4. hydromorphone 2 mg tablet sig: 1-2 tablets po q3h (every 3 hours) as needed for pain. disp:*45 tablet(s)* refills:*0* 5. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 6. sotalol 80 mg tablet sig: 1.5 tablets po bid (2 times a day). disp:*90 tablet(s)* refills:*2* 7. warfarin 5 mg tablet sig: 1.5 tablets po tonight: to be dosed daily per dr. clinic. disp:*120 tablet(s)* refills:*2* discharge disposition: home with service facility: vna discharge diagnosis: mitral regurgitation dental caries obesity rheumatic heart disease paroxysmal atrial fibrillation hypertension s/p pheochromcytoma resection s/p c-sections x4 discharge condition: good discharge instructions: shower daily, no baths or swimming no lotions, creams or powders to incisions no driving for 4 weeks and off all narcotics no lifting more than 10 pounds for 10 weeks report any redness of, or drainage from incisions report any fever greater than 100.5 report any weight gain greater than 2 pounds a day or 5 pounds a week take all medications as directed followup instructions: dr. in 3 weeks ( heart center) dr. in weeks () dr. in 3 weeks at heart center, same day as dr. . **inr draw to be called to heart center clinic-dr.- #. inr goal 2.5-3.5.confirmed with on . coumadin dosing md please call for appointments procedure: extracorporeal circulation auxiliary to open heart surgery open and other replacement of mitral valve other surgical extraction of tooth excision, destruction, or exclusion of left atrial appendage (laa) diagnoses: tobacco use disorder unspecified essential hypertension atrial fibrillation obesity, unspecified acute apical periodontitis of pulpal origin mitral stenosis with insufficiency 

Answer: The patient is high likely exposed to