Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Dual lead pacemaker in situ with the tips in the right atrium and right ventricle . Evidence of previous TAVR . Transverse cardiomegaly . Suspected left lower lobe atelectasis . Small bilateral pleural effusions . Coarsened bronchovascular markings . Pulmonary hyperinflation . No airspace consolidation . Spondylotic changes of the thoracic spine . Calcific bodies in relation to the right subcoracoid bursa .
    OUTPUT:
    
Dual lead pacemaker in situ with the lead tips in the appropriate positions . Left lower lobe atelectasis . Bilateral small effusions . Pulmonary hyperinflation coarsening of the bronchovascular markings suggestive of COPD .