Objective To explore the value of lung ultrasound combined with right heart function parameters in evaluating right heart function in patients with maintenance hemodialysis combined with pulmonary arterial hypertension. Method According to the 2022 ESC/ERS pulmonary arterial hypertension diagnosis and treatment guidelines, 95 patients with maintenance hemodialysis complicated with pulmonary arterial hypertension were divided into mild group, moderate group, and severe group, and underwent echocardiography and lung ultrasound examination. Compare the right heart function parameters and lung ultrasound score (LUS) among three groups. Evaluate the diagnostic efficacy of right ventricular systolic dysfunction using receiver operating characteristic (ROC) curve and area under curve (AUC). Result Compared with the three groups, TAPSE, FAC, S", RVFWLS, RVEF, and LVEF decreased sequentially, while LUS increased. RVEDV and RVESV increased, and the difference was statistically significant (P＜0.05). The ROC curve shows that the combination of LUS and RVFWLS has the highest value (AUC＝0.907), followed by LUS combined with TAPSE (AUC＝0.843), LUS combined with FAC (AUC＝0.817), and LUS combined with S" (AUC＝0.850). Conclusion Both left ventricular systolic function and right ventricular systolic function are reduced to varying degrees in maintenance hemodialysis patients. TAPSE, FAC, S", LUS, and 2D-STI have clinical value in evaluating right heart function in maintenance hemodialysis patients.