Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: There is a new left pectoral atrial bi-ventricular pacer / defibrillator system in place with unchanged positions of dual leads terminating in the right atrium and right ventricle and interval placement of a third epicardial lead . There is no definitive evidence of pneumothorax . The lungs are well aerated without focal consolidation or pleural effusions . Enlargement of the cardiac silhouette is unchanged with evidence of elevated pulmonary venous pressure , improved from the most recent prior chest radiograph . The patient is status post median sternotomy with multiple intact appearing wires .
    OUTPUT:
    
1 . No pneumothorax . 2 . Persistent cardiac enlargement with improved but persistent pulmonary vascular congestion / edema .