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Enlarged left atrium with carinal widening. Right atrium is enlarged due to tricuspid valve regurgitatation. Pericardial calciifcation 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 fialure. Patient is a candidate for tricuspid valve replacement.