Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: PA and lateral views of the chest were reviewed and compared to the prior studies . Evaluation of the lateral view is limited due to patient arm positioning . A new left pectoral pacer has leads ending in the expected locations of the right atrium and right ventricle . The patient is status post median sternotomy and aortic valve replacement . Sternal fixation wires are aligned and intact . Hyperinflated lungs and flattening of the hemidiaphragms is suggestive of emphysema . The lungs are clear and there is no pneumothorax . Bilateral pleural effusions are minimal if present . The heart size has decreased since ___ and is now top normal . The mediastinal contours are stable .
    OUTPUT:
    
1 . Left pectoral pacer has leads ending in the expected locations of the right atrium and right ventricle without evidence of complication including pneumothorax . 2 . The cardiac size has decreased since ___ and is now top normal . 3 . Hyperinflated lungs and flattened hemidiaphrgams are suggestive of emphysema . 4 . Bilateral pleural effusions are minimal if present .