Pathology

A 40-year-old woman with a history of rheumatic fever presents with shoness of breath, weight loss, fatigue and abdominal distension. Physical examination shows rales in the lungs, hepatosplenomegaly and 2+ pitting edema of the legs. A chest X-ray reveals only left atrial enlargement and pulmonary edema. What is the most likely cause of pulmonary edema in this patient?