Willem J. Kolff

Diastolic balloon pumping (with carbon dioxide) in the aorta—A mechanical assistance to the failing circulation

Abstract A device to provide mechanical assistance to the failing circulation is described. It consists of a catheter in a long, narrow latex tube that was inserted into the descending aorta of an anesthetized dog. The latex tube was rhythmically inflated with carbon dioxide through a pressure system, and the stroke was triggered with the aid of a timing circuit from the electrocardiogram of the animal. The stroke length and the delay after the R wave of the electrocardiogram were preset so that the latex tubing was inflated during diastole and remained deflated during systole. It was possible to increase the diastolic blood flow in the arterial system and lower the end-diastolic arterial pressure. It is hoped that the use of this device in the failing heart will result in increased diastolic blood flow, improved coronary perfusion, and decreased work for the failing left ventricle. The best indication for its use would be a failing left ventricle due to an acute coronary thrombosis.

Clinical Use of the Total Artificial Heart

We report here our first experience with the use of a total artificial heart in a human being. The heart was developed at the University of Utah, and the patient was a 61-year-old man with chronic congestive heart failure due to primary cardiomyopathy, who also had chronic obstructive pulmonary disease. Except for dysfunction of the prosthetic mitral valve, which required replacement of the left-heart prosthesis on the 13th postoperative day, the artificial heart functioned well for the entire postoperative course of 112 days. The mean blood pressure was 84 +/- 8 mm Hg, and cardiac output was generally maintained at 6.7 +/- 0.8 liters per minute for the right heart and 7.5 +/- 0.8 for the left, resulting in postoperative diuresis and relief of congestive failure. The postoperative course was complicated by recurrent pulmonary insufficiency, several episodes of acute renal failure, episodes of fever of unidentified cause (necessitating multiple courses of antibiotics), hemorrhagic complications of anticoagulation, and one generalized seizure of uncertain cause. On the 92nd postoperative day, the patient had diarrhea and vomiting, leading to aspiration pneumonia and sepsis. Death occurred on the 112th day, preceded by progressive renal failure and refractory hypotension, despite maintenance of cardiac output. Autopsy revealed extensive pseudomembranous colitis, acute tubular necrosis, peritoneal and pleural effusion, centrilobular emphysema, and chronic bronchitis with fibrosis and bronchiectasis. The artificial heart system was intact and uninvolved by thrombosis or infectious processes. This experience should encourage further clinical trials with the artificial heart, but we emphasize that the procedure is still highly experimental. Further experience, development, and discussion will be required before more general application of the device can be recommended.

First Clinical Experience with the Artificial Kidney

Excerpt As the youngest volunteer assistant in the Department of Medicine at the University of Gronigen in The Netherlands I had the care of four beds, or rather of the patients that were in them. ...

Uremic Pericarditis and Cardiac Tamponade in Chronic Renal Failure

Excerpt Uremic pericarditis has long been regarded as a sign of impending death (1-4). Since the introduction of intermittent dialysis and renal transplantation, the outlook for the uremic patient ...

Single needle dialysis.

Method and apparatus for extracorporeally dialyzing the blood of a patient with only a single venipuncture including withdrawing blood from the patient through the venipuncture and forcing the blood along an arterial path to a dialyzer. Blood emerging from the dialyzer is then conducted along a venous path again to the venipuncture. The pressure is monitored in the extracorporeal system to trigger occluding devices which alternately open and close the arterial and venous paths so that undialyzed blood is taken from the patient and dialyzed blood is injected into the patient. The apparatus includes clamps actuated by a pressure monitor to alternately obstruct the arterial and venous paths. A blood pump may be controlled to operate as one of the clamps. In an alternative embodiment, blood is circulated at a comparatively high flow rate throughout the system. A clamp is provided in one of the arterial or venous lines, said clamp being controlled by a pressure monitor. When the clamp is closed, a pressure differential is developed between the extracorporeal system and the patient so that a volume of blood is exchanged between the system and the patient.

The artificial kidney and its effect on the development of other artificial organs

67-year-old Maria Schafstaat, was our first patient whose life was saved by dialysis. She had hepatorenal syndrome and was comatose. She was in prison with other Dutch Nazi collaborators. After she had undergone 8 hours of dialysis, I bent over her and asked, “Can you hear me?” She opened her eyes and said, “I am going to divorce my husband!” I discussed my results with the highest authority on renal failure. I had chosen to use Darrow’s interstitial fluid solution for the composition of my dialyzing fluid. “But Mr. Kolff,” asked my colleague, “Why don’t you leave out the potassium? Our body is full of potassium.” I left out the potassium in the next dialysis, and in a few hours, the patient was paralyzed. The only thing he could move voluntarily was his thumb, although fortunately he continued to breathe. We did not realize at that time that potassium is not freely moveable through the cell membrane into the interstitial fluid. A total of eight artificial kidneys were made, of which four were stored in different parts of the town to reduce the risk of total elimination by bombing. Soon after the war, I gave away three of the four kidneys I had. One went to the British PostGraduate School in London at Hammersmith Hospital; one to Mount Sinai Hospital in New York; and one to the Royal Victoria Hospital in Montreal. The last one disappeared into Poland behind the Iron Curtain, and nothing has been heard of it since.

Treatment of Oliguric Glomerulonephritis with Dialysis and Steroids

Excerpt The prognosis of acute glomerulonephritis with severe or prolonged oliguria is grave (1-7). Repeated hemodialyses are justified for at least 6 weeks, to allow time for diuresis to occur (7)...

Pendulum type of artificial heart within the chest: Preliminary report

Abstract In an artificial heart the right and left ventricles need not contract simultaneously. A pendulum type of mechanical heart is described in which a small motor swings on pivots within a rigid housing, compressing each ventricle alternately. The output may be as high as 1,800 ml. per minute, and is directly related to atrial pressure. hemolysis is acceptably low. With one of these pumps an anesthetized dog maintained blood pressure, spontaneous respiration, and corneal, wink, and tendon reflexes for 5 hours. While the mechanical heart sustained the animals circulation, the following mean pressures were recorded: aorta, 150; pulmonary artery, 25; left atrium, 5; and right atrium, 17 mm. Hg.

An In Vitro Test Model to Study the Performance and Thrombogenecity of Cardiovascular Devices

During the development of cardiovascular devices, it is necessary to evaluate their performance in vitro under experimental conditions that closely resemble their use in vivo. Therefore, an in vitro test model was developed to evaluate the performance of cardiovascular devices with blood. The in vitro test model consists of a pneumatically driven 50 cc polyurethane ventricle with either mechanical or experimental polyurethane tricuspid semilunar valves, connected to a horseshoe-shaped blood reservoir. A sampling port permits frequent removal of blood for hematologic evaluation. All the couplings are of the quick connect type to facilitate assembly and exchange of parts. The total volume of blood in the test model is approximately 1.4 L, and experiments are conducted in the absence of an air-blood interface. Except for mechanical valves and the chosen test interface, the entire blood contacting surface consists of polyurethane. Fresh bovine heparinized blood is used for the experiments. After filling the reservoir and the ventricle with blood, the concentration of heparin is adjusted with protamine to an APTT level of three times normal (80-100 sec). Once this level of anticoagulation is achieved, the blood is circulated for the next 2-3 hr at the desired test parameters (beats/min, cardiac output, etc.). A number of hematologic parameters are monitored during the test, including APTT, PT, plasma free hemoglobin and ADP-induced platelet aggregation. With the help of this model a number of devices, including experimental polyurethane tricuspid semilunar valves, Silastic tube valves, valves with heparin coated leaflets, and small (50 cc) experimental ventricles have been studied.(ABSTRACT TRUNCATED AT 250 WORDS)

Treatment of renal failure with the disposable artificial kidney: Results in fifty-two patients

Abstract The results of treatment with the coil (disposable artificial) kidney in ninety dialyses in fifty-two patients described in this paper establish this type of artificial kidney as a useful tool for the treatment of uremia. The prefabricated coil kidney is more convenient to set up and easier to use than any other type of artificial kidney yet devised, and is now commercially available. Of twenty-nine patients with acute renal failure, fifteen recovered. Three more might have survived if the present concept of earlier dialysis had been fully applied to them. We now believe that a patient with severe trauma, crushing injury, fulminant infection or intoxication should be given the benefit of dialysis before chemical changes in the blood indicate impending danger. Such a patient may have to be dialyzed every two or three days. Of twenty-three patients with chronic renal failure, thirteen were in improved condition when they were discharged from the hospital. Among the symptoms and signs of uremia that improved during or after dialysis were twitching, convulsions, disturbances in sensorium, vomiting and Kussmaul respiration. Changes in blood pressure during dialysis could not always be avoided. Decreases in blood pressure, when they occurred, were controlled by transfusion of small amounts of blood. Increases in blood pressure, when they occurred, sometimes required the administration of a ganglionic-blocking agent. In five of six patients with intractable hypotension before dialysis, the increase in arterial pressure during dialysis was beneficial and could be maintained. Hemorrhages due to heparin caused no serious problems in this series. (Nasal administration of oxygen and manipulation of other tubes through the nose should be avoided.) Electrolytes were corrected in a manner that could be pre-determined by the composition of the rinsing fluid; the use of standardized rinsing fluids proved satisfactory. Urea clearance rates were determined during eleven dialyses at flow rates of 200 ml. per minute. The average clearance of 105 ml. per minute was lower than that found experimentally (130 to 140 ml. per minute). Larger blood flows, up to 340 ml. per minute, have recently been used, with an increase in clearance After dialysis a decrease of urinary output was insignificant in the patients with acute uremia but was pronounced in some of the patients with chronic uremia. The rate of ultrafiltration with the coil kidney approximates 300 ml. per hour of dialysis but it can be increased to 700 ml. Ultrafiltration is considered advantageous as most patients with uremia are edematous. Four typical case reports are presented: (1) A man in acute uremia due to crush syndrome, whose clinical condition improved after dialysis. (2) A woman with anuria following an extensive abdominoperineal operation in whom early dialysis facilitated management. (3) A woman who was maintained for sixty-three days of virtual anuria; the course in this patient proves that the artificial kidney can replace excretory renal function amazingly well. (4) A man with chronic uremia who after a single dialysis was restored to useful life for six months. The course in this patient demonstrates the possibility of worthwhile temporary improvement with one dialysis, but it also demonstrates the ultimate impotence of all measures in chronic renal disease.