Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: PA and lateral chest views were obtained with patient in upright position . Comparison is made with the next preceding portable AP single view chest examination of ___ . The patient is now examined in standing upright position . There is status post sternotomy and significant cardiac enlargement as before . Within the cardiac shadow , metallic portions of three different valve prostheses can be identified . One is a circular metallic ring in the position of the aortic valve , the second one a similar oval - shaped ring formation in the mitral valve position , and the third one an open circle rather typical for a tricuspid valve annuloplasty . Correlating the position of these valves to the outer contours of the heart , one can state that there is remaining marked enlargement of the left atrium , but the increased distance between the tricuspid valvuloplasty and the anterior heart border speaks much in favor of a right ventricular enlargement as well as an enlarged right atrium . Prominence of the ascending aortic contour is moderate . The pulmonary vasculature is presently not congested , and on previous portable examination identified edema pattern as well as evidence of right - sided pleural effusion has normalized . No new parenchymal abnormalities are seen , and no pneumothorax is identified in the apical area . Again observed is a fractured second rib in the left apical area , apparently the result of previous sternotomy and intrathoracic cardiac intervention . When comparison is extended to the next preceding PA and lateral chest examination of ___ , the patient is in better condition now as the cardiac enlargement has regressed and the pleural effusion has been absorbed completely .
    OUTPUT:
    
Marked improvement of CHF in patient with history of triple valve replacement .