The recent report by the esteemed editor of The American Journal of Cardiology and colleagues presents beautiful illustrations of examples of “isolated ventricular noncompaction … in adults.” It disturbed me because it perpetuates an extreme and restrictive view of this entity, while actual experience differs greatly. In a recent commentary, admittedly replete with speculation, I argued (1) for the acceptance of all noncompaction as congenital, whether it be found in an infant or an elderly patient; (2) for the acceptance of noncompaction as an embryonic fault that may be isolated or associated with other developmental anomalies, including genetic cardiomyopathies; and (3) that noncompaction may have a wide spectrum of presentations, from minimal to extreme, from localized to generalized, all depending on the time of onset of suspension of normal compaction and the duration of the suspension. Such framing of our thinking is in accord with today’s echocardiographic reality.