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Vito Rizzuto, the reputed head of the Montreal Mafia who built a powerful criminal organization with international tentacles, died in hospital Monday.

Rizzuto, 67, passed away of natural causes, said Maude Hebert-Chaput of Montreal’s Sacre-Coeur Hospital.

His death raises questions about the future of the Rizzuto clan’s decades-old empire, which was crippled by his 2006 extradition to the United States.

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Rizzuto was arrested by Canadian authorities in 2004 and extradited two years later to the U.S., where he was convicted for his role in the 1981 murder of three Bonanno crime-family members in New York City.

He was sentenced to 10 years in prison, minus time served while awaiting extradition.

Following his October 2012 release, Rizzuto returned to Canada to a group of family and friends whose ranks had thinned considerably.

The Rizzuto family had sustained damage in 2006 following Operation Colisee, a five-year police investigation that culminated in mass arrests in the largest sweep against the Italian Mafia in Canadian history.