Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: There is persistent severe enlargement of the cardiac silhouette . The cardiac and mediastinal silhouettes are stable . Patient is status post median sternotomy and cardiac valve replacement . Dual lead left - sided pacer device is stable in position . No focal consolidation is seen . There is no pleural effusion or pneumothorax . No overt pulmonary edema is seen .
    OUTPUT:
    
Persistent enlargement of the cardiomediastinal silhouette . Stable position of left - sided pacer device .