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: history of present illness: the patient is a 49-year-old female with a past medical history significant for rheumatic heart disease and three mitral valve replacements with porcine valve in , replaced in with a bjork-shiley. she had an mb thrombosis. the patient had progressive shortness of breath since around . catheterization on showed a right dominant system with no significant flow limiting stenosis. the resting hemodynamics revealed severely elevated right-sided filling pressures and moderately elevated left-sided filling pressures. no intracardiac shunt was present on oximetry. left with extremely severe mitral regurgitation. final diagnoses included that the coronary arteries were normal, extremely severe mitral regurgitation via bj??????rk-shiley mitral prosthesis, elevation of pulmonary capillary wedge pressure with giant b waves with systemic level pa pressure, severely depressed forward cardiac index, right atrial hypertension with tricuspid regurgitation, left ventricular systolic dysfunction, slight improvement in cardiac index, and slight fall in pvr without change in pa pressure response to intrapulmonary adenosine administration. the patient had a porcine valve placed at the clinic on which was a six week hospitalization. the patient also had a pacemaker placed. initially the patient had good symptomatic improvement after the most recent mitral valve replacement surgery and was doing well at home, able to walk and climb stairs without getting short of breath. however about one month ago, the patient started to develop progressive dyspnea on exertion. she now gets short of breath with just minimal exertion. she denies orthopnea but reports paroxysmal nocturnal dyspnea. she also reports that the edema in her lower extremities has gotten worse over the past month. past medical history: there is a history of childhood rheumatic heart disease, mitral valve replacement times three as above, history of atrial fibrillation/atrial flutter, status post pacemaker placement, and status post tab. echocardiogram on showed dilated left ventricle, decreased ejection fraction, severe global hypokinesis, significant pulmonary regurgitation, and mild mitral regurgitation. allergies: penicillin, procainamide, vitamin k. medications on admission: coreg 3.125 mg p.o. b.i.d., lasix 120 mg p.o. b.i.d., amiodarone 200 mg p.o. q.d., captopril 25 mg p.o. t.i.d., premarin 0.625 mg p.o. q.d., coumadin, kcl 20 meq p.o. t.i.d. family history: there is no family history of heart disease. social history: the patient denies the use of tobacco, minimal etoh use, and no drug use. the patient is married and has a supportive husband. physical examination (on admission): vital signs revealed temperature 96.9, heart rate 90, blood pressure 110/60, o2 saturation 94% on 4 liters nasal cannula, respiratory rate 20, weight 51 kilograms. on general appearance, the patient was pleasant and in no acute distress, lying flat. the neck revealed positive jugular venous distention to the earlobes at 30 degrees. on heent examination, oropharynx revealed moist mucous membranes, clear. pupils were equal, round, and reactive to light. cardiovascular examination revealed positive s3, regular rate and rhythm, 2/6 systolic ejection murmur at the apex. the lungs revealed slight crackles at the bases. the abdomen was soft, nontender, and nondistended with normoactive bowel sounds. the extremities revealed 2+ edema in the lower extremities bilaterally. swan was placed in the right groin. on neurologic examination, the patient was alert and oriented times three. electrocardiogram on admission showed v-paced rhythm at 92 beats per minute with left axis deviation and left bundle branch morphology. summary of hospital course: the patient is a 49-year-old female referred by dr. for cardiac catheterization. the patient was admitted off coumadin times two days and started on heparin infusion and proceeded to catheterization when inr was appropriate. cardiac catheterization on revealed a right dominant system with normal coronary arteries. the lmca, lad, left circumflex, and rca were all free of angiographically significant disease. the resting hemodynamics performed at baseline in response to studies and response to interventions are noted below. upon entry there was evidence of elevated right-sided and left-sided filling pressures with rvedp of 27 mmhg and lvedp of 30 mmhg. there was severely depressed cardiac index and severe pulmonary hypertension with a pasp of 66 mmhg. pvr was 880 dyne seconds per centimeter. the dobutamine at 7.5 mcg/kg/min and nitroprusside titrated to 75 mcg/min were begun. pasp decreased to 56 mmhg and pcwp decreased to 19 mmhg from 25 mmhg. the pvr decreased to 200 dyne seconds per centimeter. the cardiac index increased from 1.4 liters per minute per meter squared to 3.8 per minute per meter squared. the systemic arterial pressure was 98/51 mmhg. these drugs were discontinued and milrinone was begun at low dose of 0.375 mcg/kg/min following 50 mcg/kg load. the pasp was 56 mmhg, pcwp 17 mmhg, pvr 463 dyne seconds per meter squared, and cardiac index was 2.6 liters per minute per metered squared. the systemic arterial pressure was 133/57/76 mmhg. this study demonstrated reversibility of pulmonary vascular resistance and a dramatic response to inotropic and vasodilator therapy. the left ventriculography was performed demonstrating severely impaired left ventricular systolic function with a left ventricular ejection fraction calculated at 18%. there was anterobasal hypokinesis and anterolateral apical inferior and inferobasal hypokinesis. there was no significant mitral regurgitation. fluoroscopy orthogonal views of the ventricular pacing leads showed no prolapse of the right ventricular lead via the tricuspid lead. the final diagnosis was that there was severe elevation of right and left heart filling pressures with severe depression of cardiac index, no left-to-right intracardiac shunt, no mitral regurgitation, and severe left ventricular systolic dysfunction with interval further depression of left ventricular ejection fraction dilatation. there was also severe pulmonary hypertension with partial reversibility after administration of intravenous dobutamine plus nitroprusside and after intravenous milrinone. the coronary arteries were all normal. after the patient had received the right and left catheterization, she was transferred to the ccu service for swan-guided therapy and hemodynamic monitoring while on milrinone for inotropic support. it was decided that a milrinone trial would be continued for a total of five days and then an echocardiogram would be done to reevaluate her heart function. the initial milrinone dose was 0.5 mcg/kg/min and the patient showed a good response with cardiac index on milrinone. on the second day of her milrinone trial, her cardiac output and cardiac index were falling which led to milrinone increase to 0.75 mcg/kg/min. because of a drop in cardiac index, milrinone was returned to 0.5 mcg/kg/min but nipride of 0.5 mcg/kg/min was added. nipride was eventually increased to 1 mcg/kg/min due to lack of pap response. on day #3, cardiac output and cardiac index continued to decrease with an increase in svr and the nipride was titrated to a map of 70 but did not hold pressure so the nipride was eventually discontinued and the milrinone was then increased back to 0.75 mcg/kg/min which led to cardiac index and cardiac output coming back up and svr back down. while on the milrinone trial, the patient was gently diuresed to about 1 liter negative per day. in addition, the patient was maintained on captopril, coreg, and amiodarone. the plan was to wean the patient off milrinone by day five and reassess left ventricular function by echocardiogram. however the patient did not tolerate slow wean of intravenous milrinone as evidenced by increasing pats and decreasing cardiac index. the patient was therefore placed back on intravenous milrinone at 0.375 mcg/kg/min. it was then decided that the patient was likely to require continuous milrinone and require a semi-urgent transplant. on day #6 of the milrinone trial, it was decided that intravenous milrinone at 0.375 mcg/kg/min would be continued and intravenous nipride would be started in order to further decrease the pat and pvr. on , an optimal set of swan numbers were achieved while the patient was on 0.375 mcg/kg/min of milrinone and 2 mcg/kg/min of nipride. at that time, the patient's heart rate was 92 and v-paced. the arterial blood pressure was 82/39 with a mean arterial blood pressure of 54. her respiration rate was 22 and saturating at 97% on room air. the pap systolic and diastolic was 45/19 with a mean pap of 31. pulmonary capillary wedge pressure was 56. the cvp was 11. the cardiac output was 4.8 with a cardiac index of 3.2. svr was 683, pvr was 233. the patient remained stable on both current doses of milrinone and nipride and was transferred to the floor on . a formal transplant listing meeting for the patient was conducted on . the patient was accepted for cardiac transplant. per discussion with the transplant team, the patient will be transferred to cardiology on and was likely to be listed as a high status 1b for cardiac transplant. the patient will then await transplant in the hospital on continued milrinone and nitro intravenously for inotropic support. dr. of will be the attending cardiologist. additional issue with the patient was her slowly declining hematocrit during her current hospital stay. she received two units of leukocyte poor red blood cells. her latest hematocrit was 26.7. an additional unit of packed red blood cells was deferred and epogen 5000 units q. week was started. in terms of anticoagulation for her mitral valve disease, the patient was started on lovenox 40 mg b.i.d. subcutaneous administration by the patient. additional pretransplant laboratory data: pulmonary function tests, spirometry) revealed fvc actual 1.36, predicted 2.99, percent predicted 45; fev1 actual 0.85, predicted 2.26, percent predicted 38; mmf actual 0.37, predicted 2.73, percent predicted 14; fev1/fvc actual 62, predicted 76, percent predicted 83. lung volumes: tlc actual 2.33, predicted 4.88, percent predicted 52; frc actual 1.33, predicted 2.41, percent predicted 55; rv actual 1.06, predicted 1.49, percent predicted 71; vc actual 1.26, predicted 2.99, percent predicted 42; ic actual 0.99, predicted 2.07, percent predicted 48; erv actual 0.27, predicted 0.92, percent predicted 29; rv/tlc actual 45, predicted 33, percent predicted 137; nhe mixed time 2.8. dlco: dsb actual 5.65, predicted 19.3, percent predicted 29; va (sb) actual 1.95, predicted 4.48, percent predicted 44; hb 10.1; dsb (va) actual 6.41, predicted 19.3, percent predicted 33; dl/va actual 3.28, predicted 4.30, percent predicted 76%. pulmonary function test from . pulmonary function tests from repeated after discontinuation of swan catheter spirometry: svc actual 1.41, predicted 2.99, percent predicted 47%; fev1 actual 0.9, predicted 2.26, percent predicted 40; mmf actual 0.4, predicted 2.73, percent predicted 15; fev1/fvc actual 64, predicted 76, percent predicted 84. lung volumes: tlc actual 2.21, predicted 4.48, percent predicted 49; frc actual 1.43, predicted 2.41, percent predicted 49; rv actual 0.89, predicted 1.49, percent predicted 60%; vc actual 1.32, predicted 2.99, percent predicted 44; ic actual 0.77, predicted 2.07, percent predicted 37; erv actual 0.45, predicted 0.92, percent predicted 59; rv/tlc actual 40, predicted 33, percent predicted 131; he mix time 2.8. dlco: dsb actual 5.3, predicted 19.3, percent predicted 28; vasb actual 1.94, predicted 4.48, percent predicted 43; hb 9.3; dsbva actual 6.36, predicted 19.3, percent predicted 33; dl/va actual 3.27, predicted 4.3, percent predicted 76. , m.d. dictated by: medquist36 procedure: combined right and left heart cardiac catheterization coronary arteriography using two catheters angiocardiography of left heart structures diagnoses: other primary cardiomyopathies anemia, unspecified urinary tract infection, site not specified congestive heart failure, unspecified other chronic pulmonary heart diseases cardiac pacemaker in situ heart valve replaced by transplant rheumatic mitral insufficiency 

Answer: The patient is high likely exposed to