IMPRESSION:
AP chest compared to :
 
 A right transsubclavian right atrial pacer and right ventricular pacer
 defibrillator leads in standard placements, no pneumothorax, pleural effusion
 or mediastinal widening.  Previous mild pulmonary edema has improved,
 moderate-to-severe cardiomegaly has not.  There may be a new small left
 pleural effusion.  Conventional radiographs recommended when feasible for
 further evaluation.