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: mild fatigue and leg swelling major surgical or invasive procedure: redo avr/tvr (23mm regent mechanical aortic valve, 25mm on-x mechanical tricuspid valve) & replacement of permenant a&v leads & generator history of present illness: 40 yo m with rheumatic heart disease s/p mvr/tvr in . presenting following cath and recent echo which showed 4+ ai, moderate mechanical valve ms and mild tr. past medical history: -s/p mitral valve replacement with a st. bileaflet prosthesis, tricuspid valve replacement with a porcine bioprosthesis in -moderate-to-severe aortic regurgitation -hx rheumatic fever -diabetes mellitus, type 2 -atrial fibrillation -elevated cholesterol -htn social history: significant for the absence of current or former tobacco use. there is no history of alcohol abuse. he lives at home with several siblings and family members. works at airport as a baggage handler, where he has worked for >15 years. family history: there is no family history of premature coronary artery disease or sudden death. his father had diabetes. physical exam: wdwn in nad lungs ctab irregular rhythm, diastolic murmur abdomen benign extremities warm, 1+rle edema pertinent results: 02:30am blood wbc-17.1*# rbc-3.79* hgb-11.1* hct-31.9* mcv-84 mch-29.3 mchc-34.8 rdw-15.5 plt ct-156 02:30am blood pt-17.5* ptt-34.3 inr(pt)-1.6* 09:00pm blood glucose-122* urean-19 creat-0.9 na-138 k-3.9 cl-104 hco3-21* angap-17 02:30am blood alt-28 ast-66* ld(ldh)-528* alkphos-58 amylase-399* totbili-3.1* radiology final report ct head w/o contrast 8:43 am ct head w/o contrast reason: r/o stroke medical condition: 40 year old man s/p avr/tvr no movement rt side reason for this examination: r/o stroke contraindications for iv contrast: none. non-contrast head ct scan. history: status post avr/tvr. no movement on the right side. rule out stroke. technique: non-contrast head ct scan. comparison study: none. findings: there is an enormous area of low density, essentially within the entire left middle cerebral artery territory, including the left lentiform nucleus and internal capsule. there is complete effacement of the cerebral sulci and moderate mass effect exerted upon the left lateral ventricle, with a few millimeters right-sided subfalcine herniation. there is also probable mild left-sided uncal and hippocampal herniation. there is no definite accompanying hemorrhagic content within the infarct at this time. there is no hydrocephalus. there is moderate mucosal thickening within the ethmoid sinuses and to a milder degree within the maxillary sinuses, either related to intubation or an accompanying inflammatory disorder. conclusion: acute left middle cerebral artery territory infarction involving both the superior and inferior divisions. we telephoned these results to the requesting nurse practitioner and the surgical resident, dr. , immediately following the study. dr. cardiology report echo study date of patient/test information: indication: intraoperative tee for avr.tvr height: (in) 74 weight (lb): 327 bsa (m2): 2.68 m2 bp (mm hg): 115/53 hr (bpm): 56 status: inpatient date/time: at 09:52 test: tee (complete) doppler: limited doppler and color doppler contrast: none tape number: 2007aw1-: test location: anesthesia west or cardiac technical quality: suboptimal referring doctor: dr. measurements: left ventricle - diastolic dimension: *7.5 cm (nl <= 5.6 cm) left ventricle - ejection fraction: 40% to 45% (nl >=55%) mitral valve - mean gradient: 6 mm hg mitral valve - pressure half time: 125 ms mitral valve - mva (p t): 1.7 cm2 tricuspid valve - mean ts gradient: 9 mm hg interpretation: findings: right atrium/interatrial septum: moderate to severe spontaneous echo contrast in the body of the ra. a catheter or pacing wire is seen in the ra. no asd by 2d or color doppler. left ventricle: severely dilated lv cavity. mildly depressed lvef. right ventricle: rv not well seen. aorta: normal aortic diameter at the sinus level. normal descending aorta diameter. aortic valve: mildly thickened aortic valve leaflets (3). no as. moderate (2+) ar. mitral valve: mechanical mitral valve prosthesis (mvr). normal mvr leaflet motion. increased mvr gradient. mild valvular ms (mva 1.5-2.0cm2). due to co-existing ar, the pressure half-time estimate of mitral valve area may be an overestimation of true area. trivial mr. tricuspid valve: bioprosthetic tricuspid valve (tvr). increased tvr gradients. mild tr. pulmonic valve/pulmonary artery: pulmonic valve not well seen. general comments: a tee was performed in the location listed above. i certify i was present in compliance with hcfa regulations. no tee related complications. the patient was under general anesthesia throughout the procedure. the patient appears to be in sinus rhythm. results were personally conclusions: pre-bypass: 1. moderate to severe spontaneous echo contrast is seen in the body of the right atrium. 2. no atrial septal defect is seen by 2d or color doppler. 3. the left ventricular cavity is severely dilated. overall left ventricular systolic function is mildly depressed (lvef= 40 %). 4. the aortic valve leaflets (3) are mildly thickened. there is no aortic valve stenosis. moderate (2+) aortic regurgitation is seen. 5. a mechanical mitral valve prosthesis is present. the motion of the mitral valve prosthetic leaflets appears normal. the gradients are higher than expected for this type of prosthesis. there is mild valvular mitral stenosis (area 1.5-2.0cm2). due to co-existing aortic regurgitation, the pressure half-time estimate of mitral valve area may be an overestimation of true mitral valve area. trivial mitral regurgitation is seen. 6. a bioprosthetic tricuspid valve is present. the gradients are higher than expected for this type of prosthesis. severe tricuspid stenosis is present. 7. suboptimal image quality of images. post bypass 1. sub optimal image quality throughout the post bypass period. 2. biventricular systolic function is unchanged. 3. mechanical valve seen in the tricuspid position. leaflets move well and the valve appears well seated. 4. mechanical valve seen in the aortic position. initial views of the prosthetic aortic valve were poor. however subsequently reasonable short axis views obtained. the mean gradient across this 23 mm valve is 23-26 mm hg. dr aware. ( patient's bsa is 2.6 m2 ). 5. the mitral valve has not been replaced this time. the leaflets of the mitral valve from before continue to move well. 6. unable to visualize the aorta post decannulation. electronically signed by , md on 14:11. radiology final report carotid series complete 3:29 pm carotid series complete reason: assess for stenosis medical condition: 40 year old man s/p avr/tvr c/b cva reason for this examination: assess for stenosis carotid study history: stroke after valve replacement. findings: there is no appreciable plaque or wall thickening involving either carotid system. the peak systolic velocities bilaterally are normal as are the ica to cca ratios. there is slight elevation of the left eca peak velocity to 231 cm/s indicating an approximately 60% stenosis of this vessel. waveforms on the left demonstrate externalization of the common carotid waveform as well as absent antegrade flow during diastole involving the left internal carotid arteries. these findings are strongly suspicious for a high-grade stenosis or occlusion on the left, distal to the area of interrogation (more central). impression: 1. no evidence of stenoses involving the cervical carotid systems. 2. indirect findings strongly suspicious for high-grade stenosis or occlusion of more central left vasculature, i.e., intracranial left ica. dr. brief hospital course: he was admitted to cardiac surgery preoperatively for iv heparin. he was seen by dental and cleared for surgery. on he was taken to the operating room where he underwent a redo avr/tvr (mechanical) and replacement of her permenant a & v leads and generator. he was transferred to the icu in critical but stable condition on epinephrine, milrinone, phenylephrine/nitroglycerine, and propofol. he remained sedated and ventilated overnight. his sedation was then weaned and he was found to have right hemiplegia and to not follow commands. ct brain showed large left mca infarct, hyperdense left mca sign present, mass effect upon the left lateral ventricle, several mm of subfalcine herniation to the right and mild uncal and hippocampal herniation, and no bleed or atrophy. neurology was consulted and recommended serial neuro exams and ct scans, mr brain, sbp 120-160, hob > 30 degrees andcarotid ultrasound. carotid ultrasound showed no significant stenosis, but no end diastolic flow in the left cca&ica. he was seen by neurosurgery who felt that the injury would likely result in a vegetative state. he was then found to have his left pupil fixed and dilated, he was given mannitol. his neurological exam continued to deteriorate. on his r pupil was fixed and dilated and he was posturing. dr. held a family meeting with dr. and thoroughly explained the situation to the family. neurology met with the family later and the decision was made to withdraw support due to the irreversible prognosis. the patient expired at 7:01 pm on and the family was present. medications on admission: coumadin 2 mg po daily lovastatin 20 mg po daily actos 15 mg po daily glyburide 5 mg po daily lisinopril 40 mg po daily metformin 1000 mg po daily digoxin 0.25 mg po daily discharge medications: none discharge disposition: expired discharge diagnosis: rheumatic heart disease s/p redo avr/tvr/pacemaker placement htn niddm hyperlipidemia chronic afib discharge condition: expired discharge instructions: none followup instructions: none procedure: extracorporeal circulation auxiliary to open heart surgery initial insertion of dual-chamber device initial insertion of transvenous leads [electrodes] into atrium and ventricle open and other replacement of aortic valve open and other replacement of tricuspid valve diagnoses: pure hypercholesterolemia unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled cardiac complications, not elsewhere classified atrial fibrillation rheumatic heart failure (congestive) compression of brain heart valve replaced by other means atrioventricular block, complete heart valve replaced by transplant diseases of tricuspid valve hemiplegia, unspecified, affecting unspecified side rheumatic aortic stenosis iatrogenic cerebrovascular infarction or hemorrhage family history of diabetes mellitus 

Answer: The patient is high likely exposed to