Four-year-old Ruby Rosen is a little girl with a big heart. At 6 months old, Ruby was diagnosed with a heart murmur. A visit with Johns Hopkins Children’s Center pediatric cardiologist Joel Brenner, M.D., confirmed that she had a hole in her heart. In about 75% of cases, such holes in young patients’ hearts close on their own with age. But as Ruby grew, her hole grew with her.

By the time Ruby was 4, the hole was 10 millimeters, the size of a fingernail. Ruby’s cardiology team said that the hole in her heart was one of the biggest they had seen. She didn’t need emergency surgery, but would need surgery within the year. Because of the size of the hole, open-heart surgery was the only solution for Ruby. With many activities already canceled by the pandemic, her family realized Ruby wouldn’t miss out on those events during her six-week recovery period. So they decided having surgery sooner rather than later was best. “We felt like we were going to be safe at Johns Hopkins,” says Laurie Rosen, Ruby’s mom.

Ruby’s surgeon, Bret Mettler, M.D., director of pediatric cardiac surgery, along with other Johns Hopkins Children’s Center surgeons, agree that now, as well as any time, is a safe time to have surgery. “While we are living in unique circumstances with the ongoing pandemic, it’s best not to delay surgery as children’s surgery is not often considered elective,” Mettler says. He adds that delaying surgery could even be dangerous. “A child’s condition could actually worsen before surgery, which could impact the surgery once it does take place,” he says. To ensure everyone’s safety during the pandemic, the Children’s Center has put into place many policies, including patient and staff testing and increased cleaning and disinfection.

In Ruby’s case, her surgery took place in August. Mettler was able to successfully close Ruby’s heart, which meant her heart murmur also went away. Ruby is doing well, and she is proud of her new “boo-boo,” as she calls the scar from her surgery. “She’ll say ‘My heart had to get fixed to make it stronger,’” Mike Rosen, Ruby’s dad, says.

About two months after her surgery, Ruby held a pop-up lemonade stand, which offered juice boxes and individually packaged snacks, to raise money for the Blalock-Taussig-Thomas Pediatric and Congenital Heart Center. “Ruby made all the signs,” Laurie says. “You had to wear a mask, and you couldn’t eat on our lawn to keep it COVID-19 safe.” The three-hour event ended up raising $1,300 for the center.

Now that Ruby’s heart surgery is complete, her family is glad Ruby was able to have the procedure when she did. “I am so happy we did it,” Laurie says. Last week, Ruby also underwent a separate procedure at the Children’s Center to remove her tonsils and adenoids, a surgery that her doctors say needed to wait until her heart surgery took place.

Ruby, her mom, Laurie, her dad, Mike, and Mettler are available for media interviews on Ruby’s experience. Mettler is also available to discuss the importance of not delaying surgery, even during a pandemic.

Read more about pediatric surgery during the COVID-19 pandemic.