患者，男，50岁。既往有感染性心内膜炎病史，自述已治愈，未定期体检，此次因心悸、心前区不适到医院就诊，査体时在胸骨左缘第3、4肋间闻及舒张期高调、递减型、叹息样杂音，呼吸末明显。该患者最可能的诊断是

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