To the Editor,We thank Pugnaloni et al. (2021) for their comments in response to our article (Gumus et al., 2020). First of all, we would like to state that the expression "very-rare cardiac anomaly" has never been mentioned in our publication. The statement in our publication (Gumus et al., 2020) is exactly as follows: ". . . .atrioventricular canal defect (AVCD), which is a very rare anomaly in BBS patients." In other words, our statement did not specifically refer to cardiological anomalies, it was a general statement. In comparison to the frequency of the common features in Bardet-Biedl syndrome (BBS), such as retinal conerod dystrophy (94%), obesity (89%), postaxial polydactyly (79%), and kidney disease (52%), structural heart defects are among the relatively rare features of BBS (Forsyth & Gunay-Aygun, 2020).In their letter entitled "Atrioventricular canal defect is the classic congenital heart disease in Bardet-Biedl syndrome," Pugnaloni et al. (2020) refer to a study (Digilio et al., 2020) which reports 7.7% (2/26) incidence of BBS among their cohort of 26 patients with AVCD and ciliopathy. In other words, the study (Digilio et al., 2020) was not set up to answer the question of what percentage of BBS patients has AVCD. Pugnaloni et al. ( 2020) also refer to another study (Olson et al., 2019), which reports thoraco-abdominal abnormalities in six of 368 (1.6%) subjects with BBS, while this represents 170× higher prevalence of thoraco-abdominal defects in BBS; compared to the general population, the percentage of cardiac defects in BBS is much lower than that found in motile cilia disorders, like primary ciliary dyskinesia (Forsyth & Gunay-Aygun, 2020;Olson et al., 2019).In summary, while we agree that AVCD in a newborn should raise the possibility of BBS, it should always be kept in mind that the number of patients with AVCD and BBS is very low. We think it is an overstatement to claim that AVCD is the "classical" congenital heart disease in BBS.