Apparatus is provided that can be delivered through a catheter to a remote location in a patient's body. The apparatus may include a first structure that can be positioned in all dimensions in a controlled manner and stabilized in that desired position, a second structure that can then position a lumen axis at a desired angle relative to the first structure, and a third member that can pass through the lumen and approach and engage with force (e.g., penetrate) a desired location on the anatomy without compromising maintaining the desired position. The apparatus effectively separates the forces needed for positioning and the forces needed for tissue engagement (e.g., penetration).