IMPRESSION:
1.  Interval extubation and removal of the nasogastric tube.  The dual-lead
 left-sided pacer remains in place.  The patient is status post median
 sternotomy with mitral annular ring.  There continues to be bilateral diffuse
 patchy airspace process which does not appear to be significantly changed.  No
 pneumothorax is seen.  Heart remains enlarged, which may reflect cardiomegaly,
 although pericardial effusion cannot be excluded.  Overall mediastinal
 contours are unchanged.  Stable bilateral patchy airspace consolidation.