“…Specific defects of complex I [24,28], complex III [29], complex IV [7,21,39], complex III+ IV [6,20,30] and, most frequently, complex I + IV [33,34,40] have been described. There have also been reports of mitochondrial cardiomyopathy in Kearns-Sayre syndrome, with focal deficiency of cytochrome c oxidase in cardiac and skeletal muscle [25]; this presumably reflects the non-uniform distribution of normal and deleted mitochondrial DNA (mtDNA) in that disease [35]. Isolated cardiomyocytes deficient in cytochrome c oxidase were also observed in our patient, suggesting the possibility of a mitochondrially encoded defect [26].…”