IMPRESSION:
Mild pulmonary edema has improved substantially.  Moderate cardiomegaly and
 mediastinal widening, probably due to venous engorgement, persist persist. 
 Assessment of cardiac pressures is recommended to distinguish between
 biventricular heart failure with elevation of right heart pressure, and
 concurrent hemodynamically significant pericardial effusion, or alternatively
 and less likely, acute aortic dissection responsible for increase mediastinal
 diameter.
 
 Tip of the intra-aortic balloon pump has been partially withdrawn, now
 approximately 2.5 cm below the apex of the aortic knob, standard position. 
 Ascending Swan-Ganz catheter ends in the right pulmonary artery.  ET tube in
 standard placement.  Esophageal drainage tube traverses a moderately distended
 stomach and passes out of view.  No pneumothorax or pleural effusion.