Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The patient is status post median sternotomy and mitral valve prosthesis . Left - sided dual - chamber pacemaker device is noted with leads terminating in the right atrium and likely within the outflow tract of the right ventricle , unchanged . The heart remains moderately enlarged with right ventricular and left atrial enlargement . The mediastinal and hilar contours are stable . Mild pulmonary vascular congestion is noted , slightly worse when compared to the prior study . No pleural effusion or pneumothorax is present . There are no acute osseous abnormalities .
    OUTPUT:
    
Cardiomegaly with mild pulmonary vascular congestion .