Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: There is a dual - lead pacemaker / ICD device with leads terminating in the right atrium and ventricle . The patient is status post placement of both prosthetic mitral and aortic valves . Sternotomy hardware appears unchanged . There is potentially a trace pleural effusion effacing the right posterior costophrenic sulcus , but none on the left . There is moderate unfolding of the thoracic aorta . The heart is again mild - to - moderately enlarged . There is similar mild elevation of the right hemidiaphragm compared to the left . The lungs appear clear .
    OUTPUT:
    
No evidence of acute disease .