Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Left chest wall biventricular AICD is present . The patient is status post median sternotomy and cardiac valve replacements . The tip of the endotracheal tube projects over the supraclavicular region , 6 .4 cm from the carina . There is a left pleural effusion with subjacent atelectasis . Minimal right basilar atelectasis is also noted . No pneumothorax . The size of the cardiac silhouette is within normal limits .
    OUTPUT:
    
The tip of the endotracheal tube projects above the level of the clavicles , 6 .4 cm from the carina and slight advancement is recommended . Small left pleural effusion and adjacent atelectasis .