Augusta was 6 years old when in 1957 was operated at Niguarda Hospital in Milan for a severe congenital heart disease (Fallot trilogy) with a pioneering technique developed by Prof. Angelo De Gasperis, the first in Italy to operate this congenital disease since 1956Sixty-five years after her first operation, Mrs Augusta returned to the Niguarda General Hospital to be cured again.

Many years ago, on 18th November 1957, Professor Angelo De Gasperis performed a surgical operation on a six-year-old girl with Fallot’s trilogy, at Niguarda General Hospital. This was before I was born, – says Stefano Marianeschi, who is head of paediatric cardiac surgery at the hospital. – The year before, Professor De Gasperis had became the first Italian surgeon to perform surgery on this innate disorder. Initially, he faced many difficulties and resorted to palliative measures until discovering an effective method“.

In fact, Prof. De Gasperis established at Niguard the first Italian Department of Thoracic Surgery and carried out the first ‘open heart’ surgery of ventricular septal defect closure on an 18-month-old girl during the same year. This marks the initial use of extracorporeal circulation intervention in Italy.

That little girl, Augusta, was one of the lucky patients to survive that complex operation, – adds Dr. Marianeschi, – which involved opening the entire chest through a transverse thoracotomy, using femoral extracorporeal circulation and deep hypothermia“.

After 65 years her first operation, Augusta needed to replace her pulmonary valve, as its insufficiency caused her to experience fatigue with minimal exertion. At first, Mrs Augusta consulted with heart doctors at other hospitals who suggested that she should not take any action and maintain the status quo. Finally, after a few phone calls, she was referred to Niguarda General Hospital, where cardiac surgeons successfully re-intervened her heart to correct the problems that had been bothering her for some time.  Dr Marianeschi performed the operation. 

That the 6-year-old girl, who appeared in a black and white photo with Professor De Gasperis when he was featured in the newspaper for his successful surgery, – the doctor says, – has now been discharged. She is now 71 years old, and happy to have overcome this obstacle”.


Doctor Stefano Maria Marianeschi is Head of Paediatric Cardiac Surgery within the Cardio-Thoracic-Vascular Department at Niguarda General Hospital.
After completing his studies in Medicine and Surgery, he pursued specialisations in Thoracic and Cardiovascular Surgery, as well as Sports Medicine and Cardiology.
During his post-graduate period, he conducted research as a post-doctoral fellow at the University of California San Francisco and later served as a Training Instructor at Stanford University.
Since 2011, the individual has held the position of Head of Paediatric Cardiac Surgery.

The medical facility provides treatment for both paediatric and adult patients with congenital and acquired heart diseases and serves as a regional and national reference centre for heart transplantation and mechanical cardiac assistance in children.

As a General Hospital, Niguarda hosts all the disciplines for adults and children. All medical disciplines and technologies, from diagnosis to rehabilitation, are integrated aiming at serving the best care even in situations of emergency or high complexity. Physicians, scientists and nurse staff have skills to work together.

Niguarda Hospital’s exceptional standards have been recognized and honored this year by Newsweek, an American magazine that annually evaluates and publishes a list of the world’s best hospitals, assessing over 2,300 facilities in 28 countries. The hospital is currently the highest ranked public hospital in Italy and the second highest when private healthcare facilities are taken into account.

There are only 13 Italian hospitals in the world’s top 250. And thanks to its commitment, research activity, the latest technology and the contribution of its 5,000 professionals, Niguarda Hospital has climbed to 60th place on the “Best Hospital 2023” list.

The Newsweek’s ranking of the Niguarda General Hospital

Here are the specialities for which Niguarda Hospital has been ranked among the best specialized hospitals in the world:
– Obstetrics and Gynaecology: 16th in the world, 2nd in Italy
– Gastroenterology: 39th in the world, 3rd in Italy
– Oncology: 49th in the world, 5th in Italy
– Neurosurgery: 67th in the world, 3rd in Italy
– Cardiology: 68th in the world, 6th in Italy
– Neurology: 78th in the world, 5th in Italy
– Urology: 114th in the world, 6th in Italy
– Cardiac surgery: 145th in the world, 10th in Italy
– Endocrinology: 148th in the world, 9th in Italy
– Paediatrics: 201st in the world, 8th in Italy

Reference: Press release

Minimally invasive cardiac surgery for treatment of the mitral valve, aortic valve and of coronaropathy (mini sternotomy – right and left mini thoracotomy, endoscopic vessel harvesting by coronary aortic bypass)

Aneurisms or aorta dissections: direct, hybrid or endovascular treatment

Cardiac transplant

Artificial heart implant even miniaturised

Complex and rare heart disease

Diagnostics with Cardiac Magnetic Resonance

Conventional pacemakers and leadless pacemaker (inserted in the heart through a percutaneous transcatheter via the femoral vein)

Transcatheter ablation of complex arrhythmias with conventional mapping deriving from cardiac imaging obtained with Cardiac Magnetic Resonance

Resistant arterial hypertension: new minimally invasive treatment that significantly reduces arterial pressure (Hypertension Specialist, certified center to determine the patient’s eligibility for the procedure.)

Complex Pediatric cardiac surgery for infants and pediatric cardiac surgery

Comprehensive maternal-fetal counselling for mothers expecting cardiopathic children

Tetralogy of Fallot is a combination of four heart changes present at birth. There is a hole in the heart called a ventricular septal defect. There also is a narrowing of the pulmonary valve or other area along the pathway between the heart and lungs. Narrowing of the pulmonary valve is called pulmonary stenosis. The body’s main artery, called the aorta, is misplaced. The lower right heart chamber wall is thickened, a condition called right ventricular hypertrophy. Tetralogy of Fallot changes how blood flows through the heart and to the rest of the body.

For children afflicted with these rare congenital defects, one surgical operation at minimum becomes imperative owing to the complex nature of these heart diseases. The latter prominently features right ventricular overload and either an atrial septal defect or an interventricular septal defect, which lead to alterations in blood flow through the heart and lungs. Most cases of Fallot syndrome are not linked to genetic abnormalities; however, approximately 30% of patients have a specific syndrome as the cause, particularly Di George or Down syndrome.

Reference: Mayo Clinic Educational