FINDINGS:
In comparison with the study of , there is little overall
 change.  Monitoring and support devices remain in place.  Continued widening
 of the mediastinum with substantial enlargement of the cardiac silhouette,
 elevation of pulmonary venous pressure, and left effusion.  The discrepancy
 between the size of the heart and the degree of vascular congestion raises the
 possibility of underlying cardiomyopathy.