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Enlarged left atrium with carinal widening. The right atrium is enlarged due to tricuspid valve regurgitation. Pericardial calcification is seen at the margin of the enlarged left atrium. Note the prosthetic mitral valve and sternal sutures. Azygos fissure draining to an enlarged azygos vein is noted. Main pulmonary artery enlargement is seen. Dilatation of SVC and azygos vein is due to right heart failure. The patient is a candidate for tricuspid valve replacement.