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how about a GTX295 water cooled GFX card
http://www.overclockers.co.uk/showproduct.php?prodid=GX-093-BG&groupid=701&catid=56&subcat=1324

the larger HSF and 2 lil fans do not make much noise
if thats the case any gainward would probs get my votethe larger HSF and 2 lil fans do not make much noise
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NVidia tend to gear theirs towards less cooling and less noise, which means hotter cards
Where as ATI tend to go for better cooling, cooler cards, but at the expense of noisier cards