Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The patient is status post mitral valve replacement . A dual - lead pacemaker / ICD device appears unchanged . The heart is mildly enlarged . The mediastinal and hilar contours appear unchanged . The lungs appear clear . Diaphragms are flattened suggesting hyperinflation . Mild - to - moderate degenerative changes along the lower thoracic spine appear similar .
    OUTPUT:
    
No evidence of acute disease .