Shuttle PCI-E best card

I wanted a silent PCI-E card for a media centre PC. This is very
limiting of course. The really fast cards are all actively cooled,
and the fastest of the silent cards have heatsinks the size of a
packed lunch. In the end I decided on the NVidia 6600 silent card -
it hasn't arrived yet so I don't know how good a decision this was.
I wanted DVI output and performance good enough for gaming use as
much as possible. Could I have done better considering the space
restrictions (TV card in the neighbouring PCI slot)??