Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Midline sternotomy wires and LVAD device are again noted with a left chest wall AICD extending to the region of the right ventricle . Cardiomegaly is again noted , severe and not significantly changed . Hilar congestion is noted without overt pulmonary edema . No large effusion or pneumothorax is seen . No convincing evidence for pneumonia .
    OUTPUT:
    
Severe cardiomegaly again seen with pulmonary vascular congestion .