Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The lungs are clear . Changes of median sternotomy , with aortic / mitral valve replacement and tricuspid annuloplasty . Moderate cardiomegaly is unchanged . There are no pleural effusions or pneumothorax .
    OUTPUT:
    
1 . No acute process . 2 . Moderate cardiomegaly and valve replacements .