Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Right chest wall dual lead pacing device is unchanged and prosthetic valve is again noted . Median sternotomy wires are intact . Cardiac enlargement is similar compared to prior given differences in technique . There is no consolidation , effusion , or edema . No acute osseous abnormalities . Surgical clips in the upper abdomen are seen on the lateral view .
    OUTPUT:
    
Cardiomegaly without acute cardiopulmonary process .