Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The patient is status post median sternotomy and cardiac valve replacement , unchanged . There has been interval placement of a second lead arising from the right chest wall pacemaker whose tip projects over the right ventricle . Unchanged retrocardiac opacity as well as a platelike atelectasis in both lower lung zones . A small left pleural effusion is suspected . No pneumothorax identified . The size the cardiac silhouette is enlarged but unchanged .
    OUTPUT:
    
New cardiac lead arising from the right chest wall pacemaker , whose tip projects over the right ventricle . Otherwise no significant interval change in the appearance of the lung parenchyma since the prior radiograph .