Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: There has been prior median sternotomy . Heart demonstrates multi chamber enlargement has increased slightly in size since the prior study . Permanent pacemaker remains in place with leads in the right atrium and right ventricle . . The mediastinal and hilar contours are normal . The pulmonary vasculature is increased but stable since the prior study . . Lungs are clear . No pleural effusion or pneumothorax is seen . There are no acute osseous abnormalities .
    OUTPUT:
    
Marked cardiomegaly and chronic cephalization of pulmonary vasculature . No evidence of acute pulmonary edema .