Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: PA and lateral views of the chest are provided . A right chest wall pacer is again seen with leads extending to the right atrium and right ventricle . There has been a prior valve replacement , which projects over the mid heart . The heart remains moderately enlarged with a globular configuration . There is a persistent right pleural effusion which when compared with the prior exam is slightly increased in size . There is no left effusion . There is likely a component of right basal atelectasis due to compression . No pneumothorax is seen . Tiny clips project over the superior mediastinum . Bony structures are intact .
    OUTPUT:
    
Slightly increased right pleural effusion . Persistent cardiomegaly .