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Is there a specific card you are referring to, or just in general?
7600GT or 7950GT

One of my daughters has the ASUS 7600GT that's passively cooled and she games.. no issues. We run almost ALL passively cooled Vid cards at work. I have the XFX 7950GT passive, it does great. I can't even hear my system at work. Have a friend that games with the same card heavily and is experiencing no issues.
Passive technology now days is quite good - any 7600GT or 7950 on the market now with passive cooling will do fine. H-street is right, passive cooling does take up a lot of room - so be prepared for that. I think it'll be a while before we see passive cooling for the 8800's, but I can see it coming.