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: quinine / aspirin attending: chief complaint: dyspnea on exertion major surgical or invasive procedure: : redo aortic valve replacement with a . medical regent mechanical valve replacement of the ascending aorta with a 26 mm gelweave tube graft history of present illness: 75 year old woman with past medical history significant for an aortic valve replacement in with dr. . she has done fairly well since that time however had been followed for progressive bioprosthetic aortic valve stenosis with serial echocardiograms. she underwent back surgery at hospital on however her postoperative course was complicated by acute heart failure and a myocardial infarction (troponin 0.49). repeat echo showed a normal ejection fraction with severe bioprosthetic aortic valve stenosis. her aortic valve area was 0.7cm2 with a peak of 59mmhg. her preoperative peak was noted at 98mmhg with a mean of 59mmhg. she underwent a cardiac catherization which revealed left main coronary artery with an ostial 30% stenosis, left anterior descending 70% stenosis in the mid-portion, left circumflex had mild non-significant coronary artery disease and the right coronary artery had a 40% stenosis in the proximal portion. she was admitted to the cardiac service post cardiac catherization for avr/cabg on wednesday . past medical history: diabetes mellitus type 2 coronary artery disease hypertension hyperlipidemia degenerative joint disease spinal stenosis gastric esophogeal reflux disease bleeding ulcer glaucoma recent dental extraction of right lower incisor avr(#19 ce pericardial)cabgx1 (likely lima->lad)- dr. at left carotid endarterectomy roughly 25 years ago back surgery left knee replacement surgical intranasal clipping for epistaxis social history: lives with: husband in ma occupation: retired tobacco: quit 25 years ago/ 1.5ppd x 40 years etoh: rare family history: father/brother and mother with strokes. brother with cardiomyopathy physical exam: pulse: 75 sr resp: 16 o2 sat: 98% ra b/p right: 148/61 left: 133/67 height: 60 inches weight: 204 lbs general: wdwn in nad skin: warm, dry and intact. well healed left cea scar, well healed sternotomy. well healed left knee incision. heent: ncat, perrla, eomi, sclera anicteric. neck: supple full rom chest: lungs clear bilaterally heart: rrr, nl s1-s2 +s3, iii/vi systolic murmur heard at left sternal border abdomen: soft non-distended non-tender bowel sounds + extremities: warm , well-perfused trace edema varicosities: likely dilated gsv by palpation. small superficial varicosities noted. neuro: grossly intact, nonfocal pulses: femoral right:2 left:2 dp right:2 left:2 pt :1 left:1 radial right:2 left:2 carotid bruit right: + left: +++ pertinent results: : left atrium: no spontaneous echo contrast or thrombus in the la/laa or the ra/raa. all four pulmonary veins identified and enter the left atrium. right atrium/interatrial septum: no asd by 2d or color doppler. left ventricle: mild symmetric lvh with normal cavity size and global systolic function (lvef>55%). right ventricle: normal rv chamber size and free wall motion. aorta: simple atheroma in ascending aorta. simple atheroma in aortic arch. simple atheroma in descending aorta. aortic valve: bioprosthetic aortic valve prosthesis (avr). abnormal motion of avr leaflets/discs. thickened avr leaflets. severe as (area 0.8-1.0cm2). trace ar. mitral valve: trivial mr. tricuspid valve: normal tricuspid valve leaflets with trivial tr. pulmonic valve/pulmonary artery: normal pulmonic valve leaflet. no ps. physiologic pr. pericardium: no pericardial effusion. chest (pa & lat) 9:41 am clip # medical condition: 75 year old woman s/p avr final report patient is status post av replacement. a right internal jugular central venous catheter is unchanged in position. median sternotomy wires are intact. the cardiomediastinal silhouette is stable. there is mild pulmonary vascular engorgement without frank edema. the left pleural effusion is increased, with persistent bibasilar atelectasis. there is no evidence of pneumothorax. impression: increased moderate left pleural effusion. persistent bibasilar atelectasis. mild pulmonary vascular engorgement without pulmonary edema. the study and the report were reviewed by the staff radiologist. dr. dr. admission labs: 09:20am pt-12.2 ptt-24.1 inr(pt)-1.0 09:20am plt count-286 09:20am wbc-6.3 rbc-3.84* hgb-11.0* hct-32.8* mcv-86 mch-28.6 mchc-33.5 rdw-14.0 09:20am %hba1c-6.1* eag-128* 09:20am albumin-4.0 calcium-9.0 cholest-176 09:20am alt(sgpt)-11 ast(sgot)-13 ck(cpk)-45 alk phos-68 amylase-59 tot bili-0.4 dir bili-0.1 indir bil-0.3 09:20am glucose-131* urea n-21* creat-0.9 sodium-137 potassium-4.2 chloride-101 total co2-26 anion gap-14 08:50pm urine rbc-0 wbc-0 bacteria-none yeast-none epi-0 08:50pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 08:50pm urine color-straw appear-clear sp -1.018 discharge labs: 04:16am blood wbc-8.5 rbc-3.37* hgb-9.9* hct-28.8* mcv-85 mch-29.4 mchc-34.4 rdw-15.7* plt ct-333 05:30am blood pt-20.8* ptt-28.6 inr(pt)-1.9* 04:16am blood plt ct-333 04:16am blood pt-19.9* ptt-27.5 inr(pt)-1.8* 05:30am blood urean-12 creat-0.9 k-3.8 brief hospital course: she underwent cardiac catheterization and was admitted for preoperative evaluation. on she was brought to the operating room and underwent a redo aortic valve replacement with a . medical regent mechanical valve and replacement of the ascending aorta with a 26 mm gelweave tube graft. see operative note for details. the operation went without complications and the patient was transferred to the cvicu in stable condition. pod 1 found the patient extubated, alert and oriented and breathing comfortably. the patient was neurologically intact and hemodynamically stable on no inotropic or vasopressor support. beta blocker was initiated and the patient was gently diuresed toward the preoperative weight. the patient was transferred to the telemetry floor for further recovery. beta blockers were titrated up. all tubes lines and drains were removed per cardiac surgery protocol. the patient received 2 doses of 4 mg of coumadin and inr peaked at 3.6. inr was allowed to drift down and pacing wires were then removed without incidence. she was re-anticoagulated with coumadin for mechanical valve with inr goal 2.5-3.5. inr at discharge was 1.9. coumadin will be followed by dr. . the patient was evaluated by the physical therapy service for assistance with strength and mobility. by the time of discharge on pod 7 the patient was ambulating freely, the wound was healing and pain was controlled with oral analgesics. the patient was discharged home with services in good condition with appropriate follow up instructions. medications on admission: ****plavix 75mg daily- last dose due to dental extraction******* aciphex 20mg daily hctz 25mg daily- d/c'd lisinopril 20mg daily toprol xl 100mg daily (50mg xl per pt) 5mg daily lasix 40mg daily vytorin 10/80mg daily lumigan eye gtts mvi viactiv chews tylenol arthritis glucosamine & chonrotin discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*0* 2. simvastatin 40 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*0* 3. bimatoprost 0.03 % drops sig: one (1) gtt ophthalmic qhs (). disp:*1 qs 1 month* refills:*0* 4. ezetimibe 10 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 5. acetaminophen-codeine 300-30 mg tablet sig: 1-2 tablets po every 4-6 hours as needed for pain. disp:*50 tablet(s)* refills:*0* 6. metoprolol tartrate 50 mg tablet sig: 1.5 tablets po bid (2 times a day). disp:*90 tablet(s)* refills:*2* 7. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 8. lasix 40 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*0* 9. potassium chloride 10 meq tab sust.rel. particle/crystal sig: two (2) tab sust.rel. particle/crystal po daily (daily). disp:*60 tab sust.rel. particle/crystal(s)* refills:*0* 10. warfarin 2 mg tablet sig: as directed tablet po once a day: 2mg on then as directed by dr . disp:*60 tablet(s)* refills:*2* discharge disposition: home with service facility: vna discharge diagnosis: s/p redo /avr(19stjude mech)asc ao replacement pmh: non insulin diabetes mellitus, coronary artery disease, hypertension, hyperlipidemia, degenerative joint disease, spinal stenosis, gastric esophogeal reflux disease, glaucoma, s/p avr/cabg , s/p laminectomy, s/p left total knee replacement discharge condition: alert and oriented x3 nonfocal ambulating with steady gait incisional pain managed with 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 females: please wear bra to reduce pulling on incision, avoid rubbing on lower edge **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. thursday at 1:30 pm please call to schedule appointments: primary care dr. ( ) in weeks cardiologist dr. () in weeks labs: pt/inr for coumadin dosing ?????? indication mechanical avr goal inr 2.5-3.5 first draw results to dr. @ fax **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** procedure: venous catheterization, not elsewhere classified extracorporeal circulation auxiliary to open heart surgery left heart cardiac catheterization coronary arteriography using a single catheter open and other replacement of aortic valve resection of vessel with replacement, thoracic vessels diagnoses: anemia, unspecified coronary atherosclerosis of native coronary artery esophageal reflux unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled atherosclerosis of aorta other complications due to heart valve prosthesis aortic valve disorders other and unspecified hyperlipidemia old myocardial infarction knee joint replacement 

Answer: The patient is high likely exposed to