FINDINGS:
The patient is status post median sternotomy and transcatheter aortic valve
 replacement. Left-sided pacemaker device is re- demonstrated with leads
 terminating in the right atrium and right ventricle. Heart size remains
 moderately enlarged. Mediastinal contours are unchanged with diffuse
 atherosclerotic calcifications again noted. Mild pulmonary vascular congestion
 is slightly worse in the interval. Small left pleural effusion with associated
 atelectasis is present. Right lung remains otherwise grossly clear without new
 focal consolidation present. No pneumothorax is identified. Multilevel
 moderate degenerative changes are seen in the thoracic spine. Postsurgical
 changes within the left lower ribs are re- demonstrated with a bridged device
 again noted.

IMPRESSION:
Small left pleural effusion with associated left basilar atelectasis.  Mild
 pulmonary vascular congestion, slightly worse in the interval.