Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The cardiac size remains enlarged . The patient is status post median sternotomy and mitral valve replacement . Several retained wires are once again noted , unchanged . The left costophrenic angle is left off of the view of the film , but there appears to be a small pleural effusion in this area . The right lung appears clear .
    OUTPUT:
    
Overall little change since the prior examination .