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: ambien attending: chief complaint: shortness of breath major surgical or invasive procedure: aortic valve replacement (19mm mosaic ultra porcine) tricuspid valve repair (28mm - mc-3 ring) closure of patent foramen ovale history of present illness: the patient is an 84 year old white female with history as noted who has developed dyspnea on exertion over the past several months. echo revealed critical aortic stenosis, moderate to severe mitral regurgitation, and tricuspid regurgitation with preserved ejection fraction. she was referred for cardiac surgery. past medical history: coronary artery disease aortic stenosis cerebral vascular disease, s/p cerebral vascular accident with residual left lower extremity weakness sick sinus syndrome s/p permanent pacemaker hypertension hyperlipidemia peripheral vascular disease paroxysmal atrial fibrillation insulin dependent diabetes mellitus s/p stent to the left anterior descending coronary artery angioplasty/stent to popliteal artery s/p right carotid endarterectomy social history: lives with daughter tobacco: quit 20 yrs. ago, ppd x 40 years alcohol: denies family history: non-contributory physical exam: vs: 97.5, 153/71, 74paced, 18, 98% 2l gen: nad, wg, wn, wf chest: lctab cv: rrr, no murmur or rub abd: soft, non-tender, non-distended, nabs ext: 1+edema lower extremities (ankles) sternal incision: c/d/i, no erythema or drainage pertinent results: 06:10am blood wbc-9.9 rbc-3.59* hgb-10.4* hct-30.6* mcv-85 mch-28.9 mchc-33.9 rdw-15.8* plt ct-217 05:56am blood pt-14.7* ptt-26.5 inr(pt)-1.3* 06:10am blood glucose-84 urean-22* creat-0.7 na-142 k-3.2* cl-101 hco3-33* angap-11 06:10am blood mg-2.0 echocardiography report , (complete) done at 11:35:19 am final referring physician information , r. , division of cardiothorac , status: inpatient dob: age (years): 85 f hgt (in): bp (mm hg): / wgt (lb): hr (bpm): bsa (m2): indication: intraoperative tee for avr, tvr, ?mvr icd-9 codes: 440.0, 424.1, 394.2, 745.5, 424.2 test information date/time: at 11:35 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: adequate tape #: 2008aw1-: machine: 1 echocardiographic measurements results measurements normal range left atrium - long axis dimension: *5.8 cm <= 4.0 cm left atrium - four chamber length: *6.4 cm <= 5.2 cm left ventricle - inferolateral thickness: *1.5 cm 0.6 - 1.1 cm left ventricle - diastolic dimension: 4.0 cm <= 5.6 cm left ventricle - ejection fraction: 65% >= 55% aorta - sinus level: 2.7 cm <= 3.6 cm aorta - ascending: 3.0 cm <= 3.4 cm aorta - arch: 2.3 cm <= 3.0 cm aortic valve - peak gradient: *37 mm hg < 20 mm hg aortic valve - mean gradient: 21 mm hg aortic valve - lvot diam: 2.0 cm aortic valve - valve area: *0.7 cm2 >= 3.0 cm2 mitral valve - peak velocity: 0.8 m/sec mitral valve - mean gradient: 1 mm hg mitral valve - mva (p t): 1.9 cm2 findings left atrium: moderate la enlargement. elongated la. mild spontaneous echo contrast in the body of the la. no mass/thrombus in the laa. good (>20 cm/s) laa ejection velocity. right atrium/interatrial septum: mildly dilated ra. a catheter or pacing wire is seen in the ra and extending into the rv. pfo is present. left-to-right shunt across the interatrial septum at rest. left ventricle: wall thickness and cavity dimensions were obtained from 2d images. moderate symmetric lvh. normal lv cavity size. normal regional lv systolic function. overall normal lvef (>55%). right ventricle: normal rv chamber size. borderline normal rv systolic function. aorta: focal calcifications in aortic root. normal ascending aorta diameter. simple atheroma in ascending aorta. normal aortic arch diameter. complex (>4mm) atheroma in the aortic arch. complex (>4mm) atheroma in the descending thoracic aorta. aortic valve: three aortic valve leaflets. severely thickened/deformed aortic valve leaflets. severe as (aova <0.8cm2). trace ar. mitral valve: severely thickened/deformed mitral valve leaflets. no mvp. severe mitral annular calcification. severe thickening of mitral valve chordae. mild valvular ms (mva 1.5-2.0cm2). moderate to severe (3+) mr. vena contracta is >=0.7cm tricuspid valve: tricuspid valve not well visualized. moderate to severe tr. pulmonic valve/pulmonary artery: pulmonic valve not well seen. physiologic (normal) 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. no tee related complications. the rhythm appears to be a-v paced. results were personally reviewed with the md caring for the patient. conclusions pre bypass the left atrium is moderately dilated. the left atrium is elongated. 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. the left atrial appendage emptying velocity is > 20 cm/s. a patent foramen ovale is present. a left-to-right shunt across the interatrial septum is seen at rest. there is moderate symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. regional left ventricular wall motion is normal. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size is normal. with borderline normal free wall function. there are simple atheroma in the ascending aorta. there are complex (>4mm) atheroma in the aortic arch. there are complex (>4mm) atheroma in the descending thoracic aorta. there are three aortic valve leaflets. the aortic valve leaflets are severely thickened/deformed. the non-coronary cusp is immobilized. there is severe aortic valve stenosis (area <0.8cm2). trace aortic regurgitation is seen. trace aortic regurgitation is seen. the posterior mitral valve leaflet is severely thickened, calcified, and immobilized. the anterior mitral valve leaflet is moderately thickened. there is no mitral valve prolapse. there is severe mitral annular calcification. there is thickening of the mitral valve chordae. there is mild valvular mitral stenosis (area 1.5-2.0cm2). moderate to severe (3+) mitral regurgitation is seen. the mitral regurgitation vena contracta is >=0.7cm. moderate to severe tricuspid regurgitation is seen. there is no pericardial effusion. dr. was notified in person of the results in the operating room at the time of the study. post cpb normal biventricular systolic function. there is a bioprosthesis in the aortic position. it is well seated. the leaflets are not seen. there is trace aortic regurgitation the source of which can not be determined. the mean pressure gradient across the aortic valve is about 20 mm hg with a maximum gradient of about 30 mm hg. a tricuspid valve annuloplasty ring is in situ but not well seen. there is trace tricuspid regurgitation. there is some improvement in the mitral regurgitation, now moderate. the thoracic aorta appears intact. the pfo remains visible with left to right flow. i certify that i was present for this procedure in compliance with hcfa regulations. electronically signed by , md, interpreting physician 15:25 ?????? caregroup is. all rights reserved. brief hospital course: the patient was admitted on for further management of her valvular heart disease. the patient had been taking coumadin for paroxysmal atrial fibrillation. heparin drip was started, and pt/inr were reversed with vitamin k. after a discussion of the risks, benefits and alternatives to cardiac surgery, the patient was brought to the operating room on , where she underwent avr, tvrepair and closure of pfo. vancomycin was administered perioperatively given the patient's preoperative length of stay of more than 24hours. please see operative report for full details. overall the patient tolerated the procedure well, and post-operatively was tranferred to the cvicu in good condition for further monitoring and recovery. hemodynamics were supported with epinephrine, packed red blood cells and neosynephrine. by pod 2 the patient was extubated and breathing comfortably. the patient was given ambien for insomnia on the evening of pod 2. on pod 3, she was very lethargic. lethargy cleared, and the patient was transferred to the floor on pod 3. permanent pacemaker was interrogated. chest tubes and pacing wires were discontinued without complication. she was gently diuresed toward her preoperative weight. amiodarone and coumadin were resumed for preoperative paroxysmal atrial fibrillation. the patient made good progress on the floor, and was discharged to rehab on pod 6. medications on admission: asa 81' amiodarone 200' diltiazem cd 240' lopressor er 100' lisinopril 10' lipitor 10' glipizide 10' novolin 70/30 unit/day mvi protonix 40' citalopram 20' temazepam 15' coumadin 2' discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 2. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 3. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed. 4. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po hs (at bedtime) as needed for constipation. 5. bisacodyl 10 mg suppository sig: one (1) suppository rectal daily (daily) as needed for constipation. 6. metoprolol tartrate 50 mg tablet sig: 1.5 tablets po tid (3 times a day). 7. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. 8. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 9. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 10. levothyroxine 50 mcg tablet sig: one (1) tablet po daily (daily). 11. glipizide 10 mg tablet sig: one (1) tablet po daily (daily). 12. bimatoprost 0.03 % drops sig: one (1) ophthalmic qhs (). 13. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours) as needed. 14. betaxolol 0.25 % drops, suspension sig: one (1) drop ophthalmic (2 times a day). 15. apraclonidine 0.5 % drops sig: one (1) drop ophthalmic (2 times a day). 16. temazepam 15 mg capsule sig: one (1) capsule po hs (at bedtime) as needed. 17. ipratropium bromide 17 mcg/actuation aerosol sig: two (2) puff inhalation qid (4 times a day). 18. warfarin 1 mg tablet sig: two (2) tablet po once daily at 4 pm: md to dose daily for goal inr (paroxysmal a-fib). 19. albuterol 90 mcg/actuation aerosol sig: two (2) puff inhalation q6h (every 6 hours). 20. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). 21. potassium chloride 20 meq tab sust.rel. particle/crystal sig: one (1) tab sust.rel. particle/crystal po once a day. tab sust.rel. particle/crystal(s) 22. furosemide 40 mg tablet sig: one (1) tablet po once a day for 1 weeks. 23. insulin lispro 100 unit/ml solution sig: one (1) subcutaneous asdir (as directed): see attached sliding scale. 24. atorvastatin 10 mg tablet sig: one (1) tablet po once a day. 25. citalopram 20 mg tablet sig: one (1) tablet po once a day. discharge disposition: extended care facility: - discharge diagnosis: critical aortic stenosis mitral regugitation pulmonic regurgitation pulmonary hypertension s/p permanent pacemaker sick sinus syndrome h/o stroke insulin dependent diabetes mellitus hypertension coronary artery disease s/p coronary angioplasty s/p right carotid endarterectomy paroxysmal atrial fibrillation discharge condition: good discharge instructions: no driving for 4 weeks and off all narcotics no lifting more than 10 pounds for 10 weeks shower daily, no baths or swimming no lotions, creams or powders to incisions report any drainage from, or redness of 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 4 weeks () dr. in 2 weeks () wound clinic in 2 weeks please call for appointments procedure: extracorporeal circulation auxiliary to open heart surgery open and other replacement of aortic valve with tissue graft other and unspecified repair of atrial septal defect open heart valvuloplasty of tricuspid valve without replacement diagnoses: coronary atherosclerosis of native coronary artery unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled atrial fibrillation other chronic pulmonary heart diseases percutaneous transluminal coronary angioplasty status other and unspecified hyperlipidemia ostium secundum type atrial septal defect mitral valve insufficiency and aortic valve stenosis cardiac pacemaker in situ surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation accidents occurring in residential institution diseases of tricuspid valve complications affecting other specified body systems, not elsewhere classified, hypertension 

Answer: The patient is high likely exposed to