PLE-2011

A 32-year-old female patient was noted to have rheumatic heart disease. The patient comes in for a follow-up check-up since she was referred back by her cardiologist to her primary care physician. After routine vital signs checking (BP 130/60, heart rate of 96, RR of 20), the patient told her primary care physician that she was told by her cardiologist that she had developed a valvular problem as a complication of her condition. What does the primary care physician most likely think this is?