Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Pacemaker overlying the left chest with leads in the body of the right atrium , right ventricle and left ventricular coronary venous system . Small left pleural effusion . No pneumothorax . Heart size is stable . The mediastinal and hilar contours are stable . The pulmonary vasculature is normal . Lungs are clear .
    OUTPUT:
    
1 . Change in orientation of the right atrial pacemaker lead , which now resides in the body of the right atrium . 2 . Unchanged orientation of the right ventricular and left ventricular leads in comparison to the prior chest radiograph dated ___ without evidence of pneumothorax . 3 . Small left pleural effusion .